Uniform health care ID card standard expected
PAYERID likely to become national standard
The new health care identification standard, designed to support electronic data interchange (EDI) transactions by providing unique, accurate information in a standard form on patient identification cards, has been sent to the American National Standards Institute (ANSI) in New York City for final editing and is expected to be issued in early February.That’s the latest from Peter T. Barry, chairman of ANSI’s National Committee for Information Technology Standards (NCITS) for a Uniform Health Care Identification Standard.
Barry offers the following details on the new health care ID card:
1. Required identifiers on the card.
The card is an identification card, not a portable database. The standard does not specify, nor does it exclude, demographic, history, encounter, prescription, or other data on the card. It requires these identifier fields, each of which is on a separate line on the front of the card:
• card issuer number (telling which payer or other organization issues the card);
• ID (the insured’s identification number issued by the insurance company);
• name (the name of the insured).
If the payer requires another identifier, such as group number, policy number, or certificate, then that identifier must be on the card as well.
2. PAYERID is the card issuer number.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates that a national health plan identifier standard be adopted. The most likely candidate is the PAYERID identifier being developed by the Health Care Financing Administration (HCFA). HIPAA requires that HCFA issue a final rule adopting PAYERID by Feb. 28.
The PAYERID number is a nationally assigned, unique nine-digit identifier for health plans such as health insurance companies, HMOs, certain ERISA group health plans, Medicare, Medicaid, CHAMPUS, and others.
PAYERID fits within the international standards for card issuer numbers and has been approved by the ANSI USA Registration Committee as the card issuer number for identification cards used in health applications in the United States. A familiar example of a card issuer number is the bank identification number, which is the first six digits of a bank credit card number. A health card needs a number like this to identify the payer.
3. Four technologies can be used.
The standard card provides four optional machine-readable technologies. Although the technologies are optional, if any of the four technologies is used, a magnetic stripe must be used. The technologies are:
• magnetic stripe;
• contactless integrated circuit (smart card chip without electrical contacts);
• integrated circuit with contacts (smart card chip with electrical contacts);
• optical memory card (the same technology as a CD).
The identification information uses about 50 characters of the magnetic stripe. Smart card chips can store 8K or more of information. Optical memory can store up to four million characters. The standard is written so that more than 99% of the higher-capability technologies is available for other applications besides identification.
4. Embossing and portrait may be included.
The card also provides standards for embossing data characters and for putting a picture of the insured on the front of the card. This is optional.
5. The physical look of the card.
If no machine-readable technology is used, then the card can be printed on cardboard or another medium. This feature of the standard is intended to assist payers in making the transition to the card.
If one or more technologies is used, then a magnetic stripe is required. Putting a magnetic stripe on the card invokes all of the international standards for plastic cards, so the card must look much like a bank credit card.
The health identifier is one part of a set of standards and requirements for electronic transmission of health information required by what is called "administration simplification," which is mandated by HIPAA. Its goal is to streamline processes and cut costs through standardized electronic transmission of health information. The standards will apply to the entire health care industry, not just Medicare and Medicaid.
Under HIPAA, all health plans, payers, and health care clearinghouses (which process health information for reimbursement purposes) must comply with the new standards by Feb. 21, 2000. Small health plans, defined as having fewer than 50 participants, have until Feb. 21, 2001 to comply.
All health care providers who elect to transmit health information electronically must comply with the standards by those dates. The law does not require health care providers to submit transactions electronically, only that all transactions submitted electronically comply with the standards.
The standards apply to health claims or equivalent encounter information; health claims attachments, enrollment and disenrollment in a health plan, eligibility for a health plan; health care payment and remittance advice, health plan premium payments, first report of injury (for workers comp claims), health claim status, and referral certification and authorization.
Under the law, standards apply only to electronic data interchange as part of a standard transaction. Within an organization, data may be stored in any format as long as it can be translated into a standard format for the purpose of electronic transmission.
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