Early recommendations offer Payer ID insight

A June 25 letter from the National Committee on Vital and Health Statistics (NCVHS) to Health and Human Services Department Secretary Donna Shalala provides some insight into where Medicare’s National Provider Identifier (NPI) process is headed.

In its letter, NCVHS suggests the ANSI X12N 837 standard — the most commonly used electronic payment and measuring format — become the new standard for all institution and professional claims.

Reacting to concerns that payment delays would result if technical problems occur when providers and payers using other formats are forced to switch to the 837 standard, NCVHS also recommended that if providers and payers mutually agree, they can "continue to use existing flat-file mechanisms (NSF and UB92) to exchange claim transactions until February 2002."

These are the standards NCVHS is recommending be used for electronic transmission of health care-related administrative and financial information, claims and payments:

1. Health claims* or equivalent encounter information:

Pharmacy — NCPDP telecommunications standard format

Institutional — ASC X12N health care claim (837)

Professional — ASC X12N Health Care Claim (837)

Dental — ADA implementation guide for ASC X12N 837

* Note: The X12N standard for claims includes standard information for coordination of benefits.

2. Enrollment and disenrollment in a health plan

ASC X12N benefit enrollment and maintenance (834)

3. Eligibility for a health plan

ASC X12N health care eligibility/benefit inquiry (270)

ASC X12N health care eligibility/benefit information (271)

4. Health care payment and remittance advice

ASC X12N health care claim payment/advice (835)

5. Health care premium payments

ASC X12N consolidated service invoice/statement (811)

ASC X12N payment order/remittance advice (820)

6. First report of injury

ASC X12N report of injury, illness or incident (276)

ASC X12N health care claim status notification (277)

7. Referral certification and authorization

ASC X12N health care service review information (278)