Blue Cross Blue Shield of the Rochester Area
150 East Main Street
Rochester, New York 14647

August 12,1998

Health Care Financing Administration
Department of Health and Human Services
Attention: HCFA-0047-P
P.O. Box 26676
Baltimore, MD 21207-0519

To Whom It May Concern:

Blue Cross and Blue Shield of the Rochester area submits this letter as its comments and recommendations on the proposed rule for National Standard Employer Identifier (HCFA-0047-P).

The key points to our comments are as follows:

1. The proposed rule indicates that health plans are "bound" by the HWAA legislation to utilize only the FUAA standards, while employers are not. The language of the final rule must clearly state that health plans are not in violation of the law for accepting non-standard electronic transactions from nor transmitting non-standard electronic transactions to those employers who choose not to use the FHPAA standards.
("Requirements" section - page 32787, column 2)

2. The EIN has a different business purpose from the group number, account number, policy number, subscriber number, etc.. The final rule must be clear that the EIN will not be a replacement for any or all of these above numbers.
("Background" section - page 32785, columns 2 and 3)

3. The proposed rule is misleading in its statements that an employer identifier is routinely required on claim transactions submitted by providers. (Generally, this is not a true statement.) The final rule should eliminate all language that implies that the employer identifier is mandatory in any transaction set other than the ANSI 834 Enrollment transaction.
("Background" section - page 32785, column 3)

4. IRS written documentation of the EIN should be updated to more clearly describe rules or protocols for circumstances where an employer legitimately has multiple EIN'S

5. The NPRM language is both unclear and limiting through its single reference to HTML interactions. HTML is one of several current and emerging technologies that enable applications used in browser/server, Direct Data Entry (DDE) and Point of Service (POS) business scenarios. Although we support the position that these technologies not require to be HIPAA compliant, we would prefer that the actual technology (HTML, etc.) not be mentioned. Over time, newer technologies will evolve which will outdate this regulation.

6. The EIN is not explicitly included in the ID card information. 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 be present. We see no reason to include the EIN on the ID card as long as it is not required for the provider's claim submission. (Having the EIN required would force the reissue of ID cards when employment has changed, even if no benefit had changed. This would increase the administrative costs for the payer and burden the subscriber.)

Thank you for the opportunity to comment on the proposed rule HCFA-0047-P. Should there be any questions or concerns, please contact me via telephone (716-238-3669) or voice mail (716-238-3660 X3669) or email (amatina@flbcbs.com).

Sincerely,

Anne Marie Matina
Sr. Project Manager, Electronic Commerce