Draft recommendations regarding the proposed NPRM on the Employer

The following are the recommendations of the WEDI ID PAG for comments on the standard Employer Identification Number (EIN) pursuant to the Notice of Proposed Rule Making (NPRM) published in the June 16, 1998 Federal Register.

To be sent to:
Health Care Financing Administration
Department of Health and Human Services
Attention: HCFA-0047-P

Page 32791 (EIN Standard)

Should the EIN contain a check digit?

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)

Should the Hyphen utilized within the EIN be edited out when used in the 834 and other HIPAA transaction sets?

WEDI proposes that the hyphen in the EIN be edited out for transmission purposes.

Page 32791 (EIN Standard) 

Will the numbers of EINs increase as a result of HIPAA?}

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 NPRM states that employers are not bound to use the HIPAA transaction standards, but Health Plans, Clearinghouses and Providers are.  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.\line \line 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 able 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 sentence.  Providers should not be obligated to collect EIN information from the patient.

Page 32792 (Requirements)

Will Providers be required to report the EIN to Health Plans?  If so, 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)

WEDI members are concerned that the EIN may be required in HIPAA transaction sets in lieu of the employer group (a.k.a., account or policy) number.  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.

Does the standard Health Care ID card accommodate 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)

Should the WEDI ID PAG recommend creation of an employer identifier directory?

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 providers, creation of an EIN directory or other convenient access mechanism should be reconsidered.

Page 32793 (Implementation)

What is the impact of an employer having multiple EINs?

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, we recommend 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)

If a company has multiple health plans, it may have only one EIN or it may have a separate EIN for one or more of its plans.

WEDI believes that, in cases of multiple EINs, the employer will specify to the health plan 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)

Should this Rule be subject to the Paperwork Reduction Act?

WEDI recommends that this rule should not be subject to the PRA.
 

Page 32793 (Implementation)

What are the intended uses for EIN?

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)

Are EINs currently included in health care claims?

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.