Provider Identification

Lot of confusions and Ideas float in identifying a Healthcare provider.. Let it be from a remittance or any other sources, as standardization of Provider Id number is still on papers in US. So, directly coming to the point.. Lets first under stand what are the different types of provider Identification numbers used in the Healthcare Industry in this post.. and in the next post lets discuss how we can identify a Provider by reading or cracking a X12 835 / Remittance..
Lets see the different types of Identification number for providers in the Industry

1. Provider Tax Id or Federal Taxpayer’s Identification Number

2. HCFA NPI or Health Care Financing Administration National Provider Identifier now CMS NPI

3. State License Number

4. Blue Cross Provider Number

5. Blue Shield Provider Number

6. Medicare Provider Number

7. Medicaid Provider Number

8. Dentist License Number

9. Anesthesia License Number

10. Provider UPIN Number

11. CHAMPUS Identification Number

12. National Association of Boards of Pharmacy Number

13. Provider Commercial Number

14. Provider Plan Network Identification Number

15. Payee Identification

17. Unique Physician Identification Number (UPIN).

18. Facility ID Number

19. SSN

Out of these 19 different types of provider identification numbers Blue Cross Provider Number, Blue Shield Provider Number, Medicare Provider Number, Dentist License Number, Anesthesia License Number, CHAMPUS Identification Number, Provider Commercial Number, Provider Plan Network Identification Number are not commonly used..

Lets discuss about the other types of Numbers one by one.

Provider Tax Id or Federal Taxpayer’s Identification Number

Federal Tax Identification Number, is a unique nine-digit number assigned by the Internal Revenue Service (IRS) to business entities operating in the United States for the purposes of identification

HCFA NPI or Health Care Financing Administration National Provider Identifier now CMS NPI

A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
Provider UPIN Number A unique physician identification number, or UPIN, is used by Medicare to identify doctors across the United States. UPINs are six-place alpha numeric identifiers assigned to all physicians. And this will be replaced by NPI in future, previously scheduled to discontinue on second quarter of 2007.

State License Number

An Identification number given in the state of practice it varies state to state.

National Association of Boards of Pharmacy Number

This is a professional association representing the state boards of pharmacy and it provides a unique number to the pharmacists for identification these numbers are used for billing
Facility ID Number These numbers are assigned by the plan after enrolling a particular facility of a provider in its list ,this helps in locating the right facility of a Provider

Social Security number (SSN)

In the United States, a Social Security number (SSN) is a 9-digit number issued to citizens, permanent residents, and temporary (working) residents under section 205(c)(2) of the Social Security Act, codified as 42 U.S.C. § 405(c)(2). The number is issued to an individual by the Social Security Administration, an agency of the U.S. Federal Government. Its primary purpose is to track individuals for taxation purposes this number is also used to identify a provider.

In this post we saw the types of provider identification numbers ,in the next post we will see how to do a Provider Identification and validation with these numbers available in the remittance /835