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(8/14/98) - Letter of Comment to HCFA regarding Employee Identifier NPRM
August 14, 1998
Health Care Financing Administration
U.S. Department of Health and Human Services
Attention: HCFA-0047-P
309-G, Hubert H. Humphrey Building
200 Independence Ave. SW
Washington, DC 20201
RE: HCFA-0047-P
Dear Sirs:
The following represent the comments of the Workgroup for Electronic Data Interchange (WEDI) on the proposed standard for an Employer Identification Number (EIN) pursuant to the Notice of Proposed Rule Making (NPRM) published in the June 16, 1998 Federal Register.
Following its publication in the Federal Register, the proposed rule was posted to the WEDI website, along with a document generated by WEDI s ID Policy Advisory Group (PAG) which specifically highlighted the issues which the PAG felt it should carefully examine and comment upon. Comments were then received from the health care industry at large as well as members of WEDI and its Policy Advisory Group.
These comments were in turn presented to WEDI s Board of Directors for their review and deliberation. The following comments are the product of the Board s deliberations and represent the organization s official recommendations and position on these issues.
For ease of reference, each document is identified as to the page number in the Federal Register and the issue to which it pertains.
Page 32791 (EIN Standard)
WEDI endorses the selection of the Employer Identification Number (EIN), which is assigned by the Internal Revenue Service (IRS), Department of the Treasury, as the Employer Identifier Standard.
Page 32791 (EIN Standard)
WEDI discussed whether, in order to be consistent with the other identifiers, an evaluation should be done to determine whether or not the EIN be modified to add a check digit. WEDI believes that addition of a check digit might be of some limited error detection value but that there would be an inordinate burden put on existing IRS tax reporting users and the cost of modifications would be prohibitive.
Page 32791 (EIN Standard)
WEDI recommends that the hyphen in the EIN be edited out for transmission purposes.
Page 32791 (EIN Standard)
Almost all employers have EINs right now for tax reporting purposes, so WEDI does not expect any significant increase in demand for EINs. One WEDI member reports that in the small group insurance market, a "moderate" percentage of employers are using SSN and will need to convert to an EIN. Thus WEDI expects only a small additional demand for EINs due to HIPAA and believes the supply of available EINs should remain sufficient.
Page 32792 (Requirements)
The language in the first paragraph under Section II. E. Requirements specifies that "the law does not bind employers to use the standard& " but that "providers, health plans and health care clearinghouses are bound& ." As written, this would mean that health plans could only accept HIPAA standard transactions, e.g. 834, from employers, but employers do not have to send HIPAA standard transactions. In general, we are unaware of any circumstances where a provider exchanges information directly with an employer.
WEDI recommends that the language of the final rule be amended to indicate that health plans and clearinghouses must accept and transmit HIPAA standard transactions from employers who choose to use the HIPAA standard transactions. But, health plans and clearinghouses should also be permitted to accept and transmit non-HIPAA standard electronic transactions (i. e., proprietary formats) for communications with employers who do not choose to use the HIPAA standard transactions.
WEDI also recommends that the term "provider" be deleted from the paragraph noted above. Providers should not be obligated to collect and report the subscriber s or the patient s employer s EIN information.
Page 32792 (Requirements)
If providers are required to report the EIN to health plans, from where will the provider obtain the EIN? WEDI recommends that the provider not be required to report the subscriber's or the patient's employer's EIN and that Subsection 3 (Health Care Providers) on page 32792 be deleted from Section F (Requirements) in the NPRM. With the exception of the 834 Enrollment transaction, it appears that the X12N Implementation Guides specify that the EIN is optional in all occurrences. Providers are not a party to the 834 and thus would not be required to report a patient's employer's EIN. In cases where the provider does have the EIN, the provider can report it in the optional segments of the 837, for instance. WEDI supports the DHHS position that employers must disclose their EIN to legitimate users of HIPAA transaction sets when those transaction sets require the EIN. The EIN should only be required for health plan/employer transactions.
Page 32792 (Requirements) and page 32793 (Implementation)
Although the EIN is not mandated in any of the HIPAA standard transactions other than the 834 (enrollment), there may be a perception that the EIN is to be used in lieu of the subscriber's health plan identification numbers such as group number, account number or policy number. Those non-EIN identification numbers are used in the 837 (claim) and other standard transactions. WEDI emphatically notes that current transactions and adjudication systems use the group number and subscriber identification number and that those numbers must be maintained in the HIPAA transaction sets. The EIN without those other numbers would be insufficient for processing a transaction. WEDI recommends that the Final Rule make clear that the EIN should not be used as a replacement for the group and subscriber identification numbers. WEDI notes that the EIN s intended use is to identify the employer itself, not the employer s group coverage plan.
Page 32792 (Requirements)
Although the NPRM language does not specifically reference the standard health care ID card, the standard ID card would be the logical source for communication of the EIN. The NCITS 284-1997 standard health care ID card currently stipulates only the cardholder's name and ID number and the issuer's ID number, generally the PAYERID. The EIN is not explicitly included in the ID card information. WEDI sees no reason to include the EIN on the ID card as long as the subscriber's EIN is not required from the provider.
Page 32792 (EIN Standard) and page 32792 (Requirements)
Even though the EIN is not "confidential information," WEDI does not see a compelling need for creation of a directory where employers can be linked with their EINs and vice-versa. However, if use of an EIN is ever mandated for transactions typically submitted by providers, creation of an EIN directory or other convenient access mechanism should be reconsidered.
Page 32793 (Implementation)
Even if an entity has multiple EIN numbers, the current IRS protocols for handling those situations should also work for the HIPAA transactions. However, WEDI recommends that DHHS request the IRS to develop an IRS Publication explaining those protocols or revise IRS Publication 1635 ("Understanding Your EIN") to include that information. It may be prudent for DHHS to work jointly with the IRS to ensure that the protocols accurately reflect use of the EIN in the X12 Implementation Guides for the HIPAA standard transactions. In addition, WEDI recommends that the IRS Publication should be made available on-line, rather than in hardcopy only as is the case with Publication 1635 now.
Page 32793 (Implementation)
As previously stated, the intended purpose of the EIN is to identify the employer, not the employer s coverage plan. WEDI recommends that employers use one and only one EIN for HIPAA transactions. WEDI believes that, in cases of multiple EINs, the employer should specify which EIN to use. Thus we expect that the mere existence of multiple EINs for one employer will present no major obstacle to HIPAA implementation. By way of explanation we note that many large employers have their own EIN, but establish 503(c)9 trusts (with each trust having its own EIN) for their health plans.
Page 32793 (Collection of Information Requirements)
WEDI recommends that this rule should not be subject to the PRA.
Page 32793 (Implementation)
Section III. C. (Implementation, Approved Uses) on page 32793 is less than clear about the HIPAA-approved uses of the EIN. It is WEDI's understanding that use of the EIN is mandatory in the 834 Enrollment transaction, but not required in any of the other transaction sets specified in the Notice of Proposed Rule Making on Transaction Sets and Code Sets. The four bulleted "examples" listed should be clarified to reflect that only the fourth bullet (enrollment and disenrollment) is an example of a mandatory use of EIN; the other three bullets are all optional uses.
Page 32795 (Impact Analysis)
Section VII (Impact Analysis) subsection 1a. (Affected Entities, Health Care Providers) on page 32795 has language that indicates providers routinely report the patient's employer's EIN on current transaction sets. To our knowledge, providers submit only their own EIN for 1099 tax reporting purposes; providers do not submit any other employer identifiers on claim forms, except in very rare instances on an optional basis.
In concluding our comments regarding HCFA-0047-P, WEDI would like to take this opportunity to express our gratitude to the various federal government employees and others outside of the government (including WEDI s own Policy Advisory Group members) who have worked so diligently to prepare the proposed rule on these very complex transactions and issues. With its publication, our industry has taken a significant step toward the realization of the benefits of administrative simplification that Secretary of Health and Human Services Dr. Louis Sullivan and the members of WEDI articulated in 1991. We are now eager to undertake the next steps in this process. Certainly, that includes clarifying or expanding upon any of these comments during the upcoming review period, and offering any other assistance that is requested and appropriate to ensure the timely preparation and publication of the final rule.
Sincerely,
Richard P. Caliri
Chairman, WEDI
cc. WEDI Board of Directors
WEDI Policy Advisory Group Co-chairs
James A. Schuping, WEDI Executive Vice President
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