NRPM: Standard Health Care Provider Identifier. 1. Health care Providers and Health Plans


As a result of standard data format and content, health care providers and health plans that wish to do business electronically could do so knowing that whatever capital outlays they make are worthwhile, with some certainty of return on investment. This is because entities that exchange electronic health care transactions would be required to receive and send transactions in the same standard formats using the same health care provider and health plan identifiers. We believe this will be an incentive to small physicians’ offices to convert from paper to EDI. In a 1996 Office of the Inspector General study entitled “Encouraging Physicians to Use Paperless Claims,” the Office of the Inspector General and HCFA agreed that over $36 million in annual Medicare claims processing savings could be achieved if all health care providers submitting 50 or more Medicare claims per month submitted them electronically. Establishment of EDI standards will make it financially beneficial for many small health care providers to convert to electronic claim submissions, because all health plans would accept the same formats.

Additionally, we believe that those health care providers that currently use health care clearinghouses and billing agencies will see costs stabilize and potentially some cost reduction. This would result from the increased efficiency that health care clearinghouses and billing companies will realize from being able to more easily link with health care industry business partners.