The unique Health Plan Identifier (HPID) holds little to no value for stakeholders when used within electronic transactions adopted under HIPAA, according to a new survey conducted by the Workgroup for Electronic Data Interchange.
WEDIs survey, which included 262 respondents including health plans, self-insured health plans, providers, third-party administrators, clearinghouses and software vendors, found that only 15 percent of all stakeholders surveyed find any value in the use of the HPID within transactions, while 64 percent of respondents indicated that they find no value and 21 percent do not know whether there is value.
In a Sept. 19 letter to Health and Human Services Secretary Sylvia Mathews Burwell, WEDI provided the results of its survey to HHS which the organization argues further strengthen WEDIs recommendation to CMS from October 2013 that CMS modify the rule to make HPIDs not used in transactions. An HHS final rule published in September 2012 adopted a standard for a unique HPID. According to CMS, HPID is a standard identifier that was required by the original HIPAA in 1996.
Under the final rule, health plans (except small health plans) are required to obtain HPIDs by Nov. 5, 2014. Small health plans are required to obtain HPIDs by Nov. 5, 2015. All covered entities are required to use HPIDs in the standard transaction by Nov. 7, 2016. By 2016, CMS hopes to have a database that contains information about all Controlling Health Plans (those that control their own business activities, actions, or policies; or are controlled by entities that are not health plans) and associated subhealth plans.
When HHS published its final rule in 2012, the department made the case that by establishing a unique HPID it will save time and money for physicians and other healthcare providers. However, WEDI asserts that overall there is confusion within the industry as to what HPID is intended to solve in the current healthcare environment.
The industry understands the intent of the original HIPAA statute was to solve routing issues that existed more than 15 years ago, however, the industry has resolved those issues, with special attention to privacy and security risk mitigation, wrote WEDI Chairman Jim Daly to Burwell. WEDI is concerned that in order to enumerate health plans, both government and commercial funds will be required, diverting those dollars from being used to achieve healthcare goals of greater quality of care greater patient safety and reducing costs.
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