With Better Option Available, HIPAA Health Plan ID Likely Dead
The Centers for Medicare and Medicaid Services has indefinitely delayed enforcement of the HIPAA-mandated health plan identifier (HPID) and other entity identifier (OEID), development of which has already languished for many years.
The Centers for Medicare and Medicaid Services has indefinitely delayed enforcement of the HIPAA-mandated health plan identifier (HPID) and other entity identifier (OEID), development of which has already languished for many years.
The delay applies to all HIPAA covered entities including providers, insurers and claims clearinghouses. CMS is taking the action following recommendations from the National Committee on Vital and Health Statistics, an advisory body, that the HPID is no longer needed as another standard has taken its place.
NCVHS understands that the original intent back in the mid-1990s of the use of HPIDs and OEIDs was to identify health plans and clearinghouses to facilitate routing of transactions to appropriate payer recipients, the advisors told HHS in a September letter summarizing findings from two hearings earlier this year. However, the industry has moved to the implementation of a standardized national payer identifier based on the National Association of Insurance Commissioners identifier (payerID). This identifier is now widely used and integrated into all provider, payer and clearinghouse systems. This payer ID is currently the basis for routing day-to-day administrative transactions from a provider to the appropriate payer, and modifying it would create a significant disruption in the routing and processing of all administrative transactions.
Stakeholders testifying earlier this year cited lack of a business need for HPIDs now that the Payer ID is in wide use. The cost to plans, clearinghouses and providers to modify software for HPIDs also was a major concern. NCVHS heard a consistent message of the lack of benefit and value in making the switch.
The four-page NCVHS letter to HHS, which also includes comments on coordination of benefits issues and ICD-10 (encouraging Congress to not further delay), is available here.
The delay applies to all HIPAA covered entities including providers, insurers and claims clearinghouses. CMS is taking the action following recommendations from the National Committee on Vital and Health Statistics, an advisory body, that the HPID is no longer needed as another standard has taken its place.
NCVHS understands that the original intent back in the mid-1990s of the use of HPIDs and OEIDs was to identify health plans and clearinghouses to facilitate routing of transactions to appropriate payer recipients, the advisors told HHS in a September letter summarizing findings from two hearings earlier this year. However, the industry has moved to the implementation of a standardized national payer identifier based on the National Association of Insurance Commissioners identifier (payerID). This identifier is now widely used and integrated into all provider, payer and clearinghouse systems. This payer ID is currently the basis for routing day-to-day administrative transactions from a provider to the appropriate payer, and modifying it would create a significant disruption in the routing and processing of all administrative transactions.
Stakeholders testifying earlier this year cited lack of a business need for HPIDs now that the Payer ID is in wide use. The cost to plans, clearinghouses and providers to modify software for HPIDs also was a major concern. NCVHS heard a consistent message of the lack of benefit and value in making the switch.
The four-page NCVHS letter to HHS, which also includes comments on coordination of benefits issues and ICD-10 (encouraging Congress to not further delay), is available here.
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