Skip to content

"business name" and reporting clarification needed for providers with SSN only. #890

@clovis517

Description

@clovis517

Elaborating on https://github.com/CMSgov/price-transparency-guide/tree/master/schemas/in-network-rates#additional-notes
"In contractual arrangements that are only made at the TIN level, where NPIs are unknown or otherwise unavailable, the value "0" should be reported for the NPI field. In contractual arrangements where both the NPI and TIN are available, both are required to be disclosed."

The "NPI Field" is in the "Providers Object". There is not clarification regarding the "Tax Identifier Object"'s "value" when type is "npi", in situations where the provider has neither EIN nor NPI? When the NPI array is [0] I propose we allow "Tax Identifier Object" type "ein" value "0", and disallow "Tax Identifier Object" type "npi" value "0". Why? Because "ein" comes with a requirement to report "business name", and the assumption that we can look up business name from NPI does not hold true when NPI zero is used.

Metadata

Metadata

Assignees

No one assigned

    Labels

    No labels
    No labels

    Type

    No type

    Projects

    No projects

    Milestone

    No milestone

    Relationships

    None yet

    Development

    No branches or pull requests

    Issue actions