NeoTool — Singular Focus, Healthcare Integrated

Posted in Healthcare Integration, HL7 Messaging

Centers for Medicare & Medicaid Services (CMS) is pushing ahead on the implementation of the National Provider Identifier (NPI) regulations under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. In theory, there is a deadline of May 23, 2007 to use NPIs. As part of the move to NPIs, HL7 transactions can/should contain the new numbers. The good news is that HL7 has supported the use of multiple IDs for a long time via the CX and XCN data types.

Background: A user of NeoTool’s HL7 healthcare integration engine asked if HL7 was going to dedicate a field for the National Provider Identifier (NPI). The context for using NPI could be while moving HL7 charges (DFT), admission/demographics (ADT), or via master files (MFN).

In short, the XCN, PLN, and CX data types have the ability to carry an ID type or flavor. The challenge (of course) is that sending and receiving systems may or may not support this concept.

Details: Look at the CX (extended composite ID with check digit) data type definition and review sequence (component) five where it discusses HL7 table 203. This is in section 2.A.14 in HL7 2.5 and drafts of HL7 2.6. You will discover one entry in this table is “NPI” described as follows:

National Provider Identifier Class: Insurance In the US, the Assigning Authority for this value is typically CMS, but it may be used by all providers and insurance companies in HIPAA related transactions.

You can also review section 2.A.86 for details on the XCN (extended composite ID number and name for persons). While the encoding of the NPI is a bit different, the concept is the same. The ID would go in XCN.1 and the Assigning Authority goes in XCN.9 and/or XCN.22/XCN.23.

Finally, a related question popped up this week on the STC User’s Mailing List regarding master files and the NPI. In parallel to the points above, you can look at chapter 15 (Personnel Management) and chapter 8 (HL7 Master Files) to understand how the PRA segment can be used. Here PRA-6 uses the PLN (practitioner license or other Id number) data type described in section 2.A.54. HL7 Table 338 contains the code “UPIN” for “Unique physician ID no.” I’ve seen interfaces use “NPI” in this code table.

The reality is that each HL7 messaging application that sends or receives physician ID numbers will choose where the data should be sent or received.

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