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National Health Care Identifiers

National Health Care Identifiers. Peter T Barry March 13, 2002 peterbarry@aol.com. National Provider Identifier. Issued to individuals and organizations Multiple NPIs thru Organizational NPI Provider, not payer, controls application for NPI

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National Health Care Identifiers

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  1. National Health Care Identifiers Peter T Barry March 13, 2002 peterbarry@aol.com

  2. National Provider Identifier • Issued to individuals and organizations • Multiple NPIs thru Organizational NPI • Provider, not payer, controls application for NPI • Optional for provider to get NPI, sort of • Suggest payers encourage providers to get NPI

  3. National Provider Identifier • But some providers will not have NPIs • Expected to be 10 digits • National NPI database to contain • N&A, telephone, etc • Provider Taxonomy code • Not expected to have EDI Addess • Effective date of update

  4. National Provider Identifier • Providers will apply for NPI, not be assigned • Database will be maintained by providers or maintainers they delegate • When? This year, maybe sooner than we think • Not integrated with Digital Signature

  5. National Provider Identifier • Means of making NPI database available • Real-time cached computer access • Replication to users’ computers • Maybe periodic CD Rom • Will the database have high accuracy and be up-to-date?

  6. National Health Plan Identifier (PlanID) • PlanID issued to: • Payers • Self-funded group health plans • Insured group health plans (4 million) • Certain agents of plans such as TPAs, ASOs • Expected that a plan can get more than one PlanID • Mandatory for plan to get PlanID

  7. National Health Plan Identifier (PlanID) • Health plans will apply for PlanID, not be assigned • PlanID will be put on health identification cards • Database will contain: • N&A, Description, etc. • EDI Addresses • Cross reference to other identifiers • Effective dates

  8. National Health Plan Identifier (PlanID) • Computer system similar to NPI’s, should be the same system. • Why are insured group health plans included? (4,000,000)

  9. Other • National Employer Identifier • Unique health care identifier for individuals • Major issue with NPI and PlanID • Have to implement before available • Means infrastructure built without them

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