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Health Plan Identifier (HPID)

Background

In March 2010, HIPAA Administrative Simplification provisions were amended through the enactment of the Patient Protection and Affordable Care Act (ACA). The ACA establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs. Specifically, in section 1104(c)(1) of the ACA and section 1173(b) of the Social Security Act, Congress required the adoption of a standard for a unique HPID.

On September 5, 2012, the Department of Health and Human Services (HHS) published a Final Rule which adopts a unique identifier (HPID) for Health Plans as defined in the HIPAA Transactions and Codes Sets Final Rule. The HPID will be assigned by the Enumeration System. A Controlling Health Plan (see below) must obtain an HPID for itself and may obtain an HPID for a subhealth plan of the Controlling Health Plan or direct the subhealth plan to obtain an HPID from the Enumeration System.

Key Facts:

  1. Effective Date for Final Rule November 5, 2012.
  2. Covered Entities must use HPIDs in the standard transactions on or after November 7, 2016.
  3. Compliance Date for Health Plans with the exception of small plans must obtain a HPID by November 5, 2014.
  4. Small Health Plans must obtain a HPID by November 5, 2015.
  5. The proposed format of the HPID and Other Entity Identifier (OEID) is a 10-digit, all-numeric identifier with a Luhn check-digit as the tenth digit. CMS is seeking comments on this format. The proposed enumeration would have the HPID and OEID first position a different number.

Resources:

Below are external links that will lead you away from the Department of Health Care Services.

HIPAA Federal Resources

HPID Final Rule

WEDI HPID Workgroup

 

 
Last modified on: 3/12/2015 2:17 PM