Inventory of Health Care Information Standards. Health Care Providers

01/01/1997

4.1. Unique Identifier Standards for Health Care Providers:

None Exists

4.2. Unique Identifier Options for Health Care Providers:

4.2.1. National Provider Identifier (NPI)

I. Description of Standard

The NPI is an eight-position alphanumeric identifier. The eighth position is an International Standards Organization-approved check digit, which will allow a calculation to detect keying or transmission errors. The National Provider System will assign the NPI and will also assign two-position alphanumeric location identifiers to indicate practice locations of the provider. Neither the NPI nor the location identifiers will have embedded intelligence. That is, information about the provider, such as the type of provider or state where the provider is located, will not be conveyed by the NPI. This information will be recorded in the system, but will not be part of the identifier. Individual and group providers will receive location identifiers for their office practice locations. Individuals and groups will not receive location identifiers for the hospitals or other organization providers where they practice, since these organization providers will receive their own NPIs. The NPIs of individual providers who are members of a group will be linked to the NPI of the group. The relationships defined among organization providers differ, depending upon the specific business rules of different health programs. The National Provider System will enumerate organization providers at the elemental level, so that different health programs can link these providers according to their program-specific business rules. Each organization provider in a separate location will receive a separate NPI. Each member of an organization chain and each part of an organization provider that needs to be identified will receive a separate NPI. The National Provider System will have a query facility that will link organization providers that have a common Employer Identification Number. Organization providers will have only one active location identifier.

II. Readiness of Standard

HCFA's schedule for implementation of NPI is listed below.

Notice of Proposed Rule Making Published in

Federal Register 02/21/97

Final Regulation Published in Federal Register 07/02/97

NPIs Issued to Medicare Providers No Later Than 08/01/97

Required Use of NPI for Medicare claims 12/01/97

III. Contact for more information

Robert Moore

HCFA

7500, Security Blvd.

Baltimore, MD 21244

IV. Indicators of Market Acceptance

N/A

V. Identifiable costs

None

4.2.2. Unique Physician Identifier Number (UPIN)

Description of Standard

HCFA created UPIN as required by COBRA to identify physicians who provide services for which payment is made under Medicare. UPIN is a six-place alphanumeric identifier. The UPIN Registry is the carrier that maintains the UPIN. A total of 704,926 UPINs have been assigned to 2,088,309 physicians.

Readiness of Standard

UPIN addresses only a small segment of the provider community i.e. physicians with dedicare practice. HCFA's current proposal of National Provider File/NPI replaces UPIN with NPI.

Contact For More Information

Robert Moore

HCFA

7500, Security Blvd.

Baltimore, MD 21244

Indicators of Market Acceptance

N/A

Identifiable costs

None

4.2.3. National Association of Boards of Pharmacy Number

(NABP Number)

I. Description of Standard

Each licensed pharmacy in the United States is assigned a unique seven-digit number by the National Council for Prescription Drug Programs (NCPDP), in cooperation with the National Association of Boards of Pharmacy. The purpose of this system is to enable a pharmacy to identify itself to all third-party processors by one standard number. The first two digits of the NABP Number denotes state designation. The second group four digits identify the pharmacy and assigned sequentially from 0001 up. The last digit is a check-digit.

II. Readiness of Standard

NABP Number is currently in use by pharmacies in United

States.

III. Contact for more information

Noe Gomez

NCPDP/NABP

4201 North 24th Street, Suite 365

Phoenix, AZ 85016

IV. Indicators of Market Acceptance

NABP Number is currently in use by pharmacies in United

States.

V. Identifiable Costs

None

4.2.4. Health Industry Number (HIN)

I. Description of Standard

HIN is used as an identifier for contract administration in the health industry supply chain, as a prescriber identifier for claims processing and for market analysis applications. It enumerates prescriber by location, provider establishments and other entities in the health industry supply chain. The Identifier includes a "base HIN" consisting of seven (7) character identifier and a two (2) character suffix to identify the location of the prescriber.

II. Readiness of Standard

HIN has been in use since 1987 in the health industry

supply chain and in state-administered claims processing.

III. Contact for more information

Robert A. Hankin, Phd, President,

HIBCC

5110 North 40th Street, Suite 250

Phoenix, AZ 85018

IV. Indicators of Market Acceptance

According to HIBCC, HIN is endorsed or being implemented by the following:

American Hospital Association (AHA)

American Medical Association (AMA)

American Nurses Association (ANA

American Society for Automation in Pharmacy (ASAP)

American Veterinary Distributors Association (AVDA)

Animal Health Institute (AHI)

Centers for Disease Control & Prevention (CDC)

Health Industry Distributors Association (HIDA)

Health Industry Group Purchasing Association (HIGPA)

Health Industry Manufacturers Association (HIMA)

Healthcare Information and Management Systems Society (HIMSS)

National Wholesale Druggists' Association (NWDA)

Pharmaceutical Research and Manufacturers Association (PhRMA)

State of Tennessee, TennCare Program

US Department of Defense (DoD), Defense Personnel Support Center (DPSC)

V. Identifiable Costs

There is no cost to entities enumerated on the database.