PAYERID: More Than A Number

PAYERID^TM

. . . more than a number^TM

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NOTE: PAYERID ^TM is a HCFA initiative to enumerate health plans under the Health Insurance Portability and Accountability Act of 1996. This document reflects HCFA's current thinking on this initiative, but does not constitute a final methodology, format, or proposal. Additional changes and improvements may be made as HCFA continues to develop the enumeration initiative. An opportunity for public comment will be provided through a Notice of Proposed Rulemaking that will be published in the Federal Register. PAYERID^TM and PAYERID...more than a number ^TM are trademarks and service marks of the Health Care Financing Administration.

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Background

In April 1994, the Health Care Financing Administration (HCFA) began development of a unique identifier that would allow all health care payers, including Medicare and Medicaid, to use one national numbering system to identify each health plan that provides health care benefits for people in the United States. The unique identifier would facilitate the electronic transmission of claims and other health care transactions. HCFA called this unique numbering system PAYERID. HCFA's goal for PAYERID was to simplify, standardize, and otherwise improve the process of exchanging electronic health care information.

In August 1996, the Congress passed the Health Insurance Portability and Accountability Act (HIPAA) requiring the Secretary of DHHS to adopt a standard health identifier for health plans. Use of this identifier would apply to all health care plans, health care providers, and health care clearinghouses that transmit electronic health care transactions. In response to HIPAA, HCFA expanded its payer identifier to include in the enumeration health plans and self-insured employer group health plans.

Entities Enumerated

• Health Plans:
  
  • Group health plans
  • Health insurance issuers
  • Managed care organizations (HMOs)
  • Medicare program
  • Medicaid program
  • Medigap plans
  • Long term care plans
  • Employee welfare benefit plans offered by two or more employers
  • Active military plans
  • Veterans health care program
  • Civilian Health and Medical Programs of
    the Uniformed Services (CHAMPUS)
  • Indian health service program
  • Federal Employees Health Benefit Plan
    
• Employers (those that offer self-insured health benefits)

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HCFA will propose through the regulatory process that the Secretary of DHHS adopt PAYERID as the standard unique health identifier for health plans . Under this proposal, HCFA would be the authorizing agent for enumeration through the services of a PAYERID Registrar.

PAYERID...more than a number ^TM

The PAYERID is more than just a number. It is also a registry, an electronic phone directory, and a system.

• As a number, the PAYERID consists of nine positions. The ninth position is a check digit to verify accuracy of data entered. Each health plan would receive one PAYERID. In addition, each smaller health plan within the larger plan's business structure, such as those that include one or more managed care, indemnity, and other type plans, would each be assigned its own PAYERID. All affiliates would be linked to the larger health plan's PAYERID. The associated database will provide contacts, telephone numbers, mailing addresses, EDI addresses, and other information to enable users to route claims and other health care transactions correctly. No PAYERID would be assigned to the "product lines" of a health plan.
• As a registry, all PAYERID numbers will be listed in the database or the directory (a subset of the database).
• As an electronic phone directory, all business related information about a specific entity will be available.
• As a system, PAYERID will have the capacity of enumerating 100 million entities, allow for on-line maintenance of information by the entity associated with the number, and provide the mechanism for downloading the database to Registry Users.

PAYERID Registration

The PAYERID initiative is populating its initial file of potential applicants, using sources such as the HCFA files of Medicare contractors, Medigap insurers, and Medicaid state agencies. To this file, it has added the names of health insurance companies, managed care organizations (formerly HMOs), and self-administered plans obtained from several payer associations.

The enumeration process will be completed in phases. Phase I will include all entities that currently do business with Medicare; the remaining health plans will be in Phase II. HCFA will conduct an outreach program to educate Medicare hospitals, physicians, and other providers on how to use the PAYERID on health care transactions. Publicity and education efforts would then be extended to all plans and employers involved in electronic health care commerce.

Consultation

To ensure acceptance of the PAYERID initiative, HCFA is consulting with industry and standard organizations such as the National Uniform Claim Committee (NUCC), the National Uniform Billing Committee (NUBC), the National Council for Prescription Drug Programs (NCPDP), the American Dental Association, the American National Standards Institute (ANSI), the American Dental Association (ADA), the Workgroup for Electronic Data Interchange (WEDI), and the National Council on Vital and Health Statistics (NCVHS).

A Few Final Thoughts

• The PAYERID will replace the current numbering and naming conventions used today for all electronic health care transactions.
• The PAYERID assigned to an entity will be retired and never used again if the entity associated with the number ceases to exist (e.g., mergers, buy-outs, etc.).
• The PAYERID may be used to determine an entity's processing locations.
• The PAYERID may be used to identify addresses for the routing of different types of health plans (HMO, PPO, etc.)