provider_group_id is unique at what level/namespace?

[theogaraj]

This portion of the schema defines the Provider Group Id as:

The Provider Group Id is a unique interger ID that is defined by the user to be referenced in the Negotiated Rate Details Object in the provider_references array.

I don't expect it to be unique across different issuers. But for a given issuer, at what level is it intended to be unique? I have seen cases where issuers have multiple in-network files referenced by a single table of contents file. Also seen cases where a single issuer has multiple TOC file (each in turn, referencing multiple in-network files). and there are cases where an issuer (Aetna is an example) has broken up their files by line of business.

So my questions are:

• for @shaselton-usds: at what level does the spec intend the provider_group_id to be unique?
• for payers that are reading this: when creating your files are you treating provider_group_id as unique across all of your data or only within some smaller namespace?

[shaselton-usds]

Hey @theogaraj, thanks for the question -

The in-network files should contain all of the necessary information to stand alone. This means that whether an in-network file leverages external provider reference files (which is recommended for both sizing issues and reusability) or the provider_references array at the root of the in-network file, the provider_group_id should only apply to the data that is in that file. There isn't any other way for the consumers of the files to match a provider_reference object that would be defined outside of the in-network file.

[theogaraj]

@shaselton-usds thanks for the response.

I was originally going to disagree with the rationale, but your reasoning makes sense now I realize that a given issuers files may include in-network files generated by another entity (could be leased or shared networks). So Issuer A's TOC might reference files generated by Issuer A as well as files generated by Issuer B (where Issuer A has no control on what identifiers are used by Issuer B).