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Identifiers

Currently health care organizations can and do assign proprietary identifiers to identify health care providers, employers, health plans and individuals. The issues surrounding the use of non-standard or proprietary identifiers are similar to those the Federal government identified for non-standard electronic health care transactions. Lack of standardization has lead to system incompatibilities, administrative inefficiencies and accuracy problems.

Regulations for National Provider and National Employer Identifiers are still in the proposed rule stage and have not been finalized. The National Health Plan Identifier is in the rule development stage, and to date, the Individual Identifier has been placed on hold.

National Provider Identifier

Under a proposed standard related to EDI (electronic data interchange) formats, National Provider Identifiers (NPI) would be assigned to all providers and used by both public and private health plans. As proposed in the Federal standard, NPIs would be used by all health organizations that conduct HIPAA-specific electronic transactions.

The NPI was proposed as an 8-digit alphanumeric identifier. However, many commenters on the proposed rule prefer a 10-digit numeric identifier. Finalization of the specifications are expected in the near future.

National Employer Identifier

Employers frequently also have to be identified in electronic health care transactions. The adoption of the Employer Identification Number (EIN) as the standard unique identifier for employers in the filing and processing of health care claims and other transactions became effective July 30, 2002.

The EIN is issued and maintained by the Internal Revenue Service (IRS). Businesses that pay wages to employees already have EINs. The identifier has nine digits with the first two digits separated by a hypen as follows: 00-0000000.

The US Department of Health and Human Services website contains additional information and frequently asked questions about the various identifiers rules.