Frequently Asked Questions on Payer ID

1. Why Payer IDs instead of using the FEIN?

                       The most important reasons to use the Payer ID instead of the FEIN are:

• Provider's systems typically don't have enough storage space for the FEIN. Most of them allow for only 5 bytes to identify the Payer ID.
• The old NSF and UB82 flat files, still very much in use by providers, only have 5 bytes for Payer ID.
• The common Payer IDs used under HIPAA are 5 bytes long.
• Using the NAIC co-codes is the most common way to enumerate payers under HIPAA. Practically all clearinghouses use these today.
• We are trying to re-use as much as possible, without making provider change their systems.
• Some Carriers will need/want to use multiple Payer IDs in order to separate their lines of business, even if they only have one FEIN or one NAIC Co-code.
• Some Carriers will need/want to use one single Payer ID for all their lines of business, even if they have multiple FEINs.
• The Bill Review companies, PPOs and TPAs will need to be enumerated with a Payer ID for purposes of routing these eBill transactions.
• Assigning Payer IDs that are not totally dependent on the FEIN or the NAIC Co-code gives us the needed flexibility.
• The NAIC Co-code is the standard starting point for Payer ID assignment.

2. How many Payer ID numbers do I need?

   Most likely you need only one. Commercial Carriers, Self Insured entities, Self Insured government entities, Third Party Administrators, Bill Review companies, etc. should get their own unique Payer ID.

    

   However, there are some cases where you may want to request several Payer IDs. For example, some payers process the bills in specific business units that administer certain contracts or certain claims. In that case, they may want to have a Payer ID for each one of those units. In some cases the units could have different mailing addresses or different PO Boxes, and it is easy to understand the correlation of Payer IDs with PO Boxes or mailing addresses. In other cases the Payer IDs may actually reflect two different computer systems processing the claims, perhaps due to a transition from one system to another or due to the merger of two companies.

    

   Another example is that if you are a Bill Review company or TPA processing eBills for multiple Carriers and your system cannot determine the Carrier unless the provider indicates the Carrier on the eBill itself, then you will probably need one Payer ID for each of your Carrier customers. Perhaps you can "borrow" the Payer ID of your customers, or, more likely, you will need to obtain a Payer ID that reflects the fact that you process eBills for that particular Carrier. This is especially true when some of your competitors also process eBills for that particular Carrier. In that case, the TPA+Carrier combination would be represented by a Payer ID.

    

   The bottom line is that you ought to get as many Payer IDs as you need to conduct your business. You could think of them as electronic PO Boxes. The more Payer IDs you get, the finer the granularity of the system, but the complexity increases for the provider. The easiest for the providers is to know you by one Payer ID.

    

3. Do clearinghouses need a Payer ID?

   No. A clearinghouse processes transactions for many payers and providers and does not have a Payer ID of its own.

    

4. How do I get a Payer ID assigned to me?

   If you need a Payer ID for use in Texas, and there is not one already assigned to you, you can send a request for a Payer ID to the TXCOMP Help Desk by sending an email to TXComp.Help@tdi.state.tx.us. Please include your company name, complete mailing address, and FEIN (Tax ID) as well as contact information (email, phone, fax) and your classification as Commercial Payer, Self Insured, TPA, etc. If you are a Commercial Payer you must include your 5 digit NAIC Company Code in the request for Payer ID. The TXCOMP Help Desk will verify your request and will assign a number to you. The turnaround should be about 3 work days. There is no charge for Payer IDs at this time.

    

   For Payer IDs for California or for other states we will have asimilar process posted on this page soon.

    

   We will be discussing the Proposal from Enumeron to assign standard Payer IDs from a central location that can be used nationwide.

    

5. How often is the Payer ID spreadsheet published?

   The spreadsheet will be posted periodically to the TDI web site. Initially, since we expect a lot of requests for Payer IDs in preparation of the 1/1/08 deadline, the spreadsheet will be refreshed twice a week, on Tuesdays and Thursdays, and after the initial push is over it will probably be refreshed on a monthly basis. The spreadsheet, or a link to it, will also be available through the SeBIN and WEDI web sites. (The current spreadsheet has not been updated since January '08.)

    

6. How will the providers know which Payer ID to use?

   The providers should receive this information in exactly the same way they receive the information as to where to mail a paper bill today. In some cases they would ask the employee or the employer. When the provider asks the employee or the employer where to send the eBills, the employer should direct the provider to send the eBills to the entity that is going to process the eBills, whether this is a TPA or a Carrier, and give the provider that entity's Payer ID.

    

   The providers should use the Payer ID of the entity that is going to receive the electronic bills. In general, this will be the TPA or Claim/Bill Administrator's Payer ID. In some cases the administrator is the Carrier itself and the provider will use the Payer ID even if it happens to be a Carrirer in those cases. The primary use of the Payer ID is to route the eBills to their destination, that is to send the electronic bill to whomever is going to process the bill for payment.

    

   However, the fact that the provider knows what is the Payer ID that needs to be used does not mean that the provider has connectivity to that payer. The provider should check with its clearinghouse to determine if the connectivity to that Payer ID is in place. In some cases the connectivity to a payer may be in place though a clearinghouse only for certain Payer IDs, whereas other Payer IDs (even for the same payer) cannot yet be sent electronically through the provider's clearinghouse. As the clearinghouses interconnect to each other, this situation will change and we will soon have universal connectivity. But we are not there yet...

    

7. How will the employers know which Payer ID to use?

   Ask your Carrier or your Claim or bill administrator. The empoyers should use the Payer ID of the entity that is going to process the electronic bills. In general, this will be the TPA or Claim/Bill Administrator's Payer ID. In some cases the administrator is the Carrier itself and the employer will use the Payer ID even if it happens to be a Carrirer in those cases. The employer should direct the provider to send the eBills to the entity that is going to process the eBills, whether this is a TPA or a Carrier, and give the provider that entity's Payer ID.

    

8. I am a TPA, how do I find out my Payer ID?

   First look on the spreadsheet. Do you see your name there? If you are already listed, the Payer ID should be listed between your name and your FEIN. Please review the rest of your listing and send an update request to the TXCOMP Help Desk to make sure it is correct. If you don't see your name already listed, you can send a request for the assignment of a Payer ID to you by following the directions on FAQ #4.

    

   If you need more than one Payer ID for your business, you can ask for as many as you need. However, if you have multiple Payer IDs, each one should have a well defined purpose, so you don't end up with the eBill sent to the incorrect Payer ID.

    

9. I am a Carrier, how do I use my Payer ID?

   If you receive the eBills through a TPA, you probably don't need to use your Payer ID. Most of the time the providers will need your TPA's Payer ID and may never use yours. If you receive the eBills directly from the providers then the provider will need your Payer ID in order to route the eBills to you.

    

   If you need more than one Payer ID for your business, you can ask for as many as you need. However, if you have multiple Payer IDs, each one should have a well defined purpose, so you don't end up with the eBill sent to the incorrect Payer ID.