Policy & Regulation News

CMS updates Health Plan Identifier system

By Elizabeth Snell

- The Centers for Medicare & Medicaid Services (CMS) announced earlier this week that its Health Plan and Other Entity Enumeration System (HPOES) has been updated with new functionality. Now, HPOES lets multiple controlling health plans (CHPs) register for a health plan identifier (HPID) using a single employer identification number (EIN).

Health plans use HPOES to apply for an HPID. According to CMS, an HPID is required to be used in the standard transactions to identify a health plan that has an HPID and is also allowed to be used for any other lawful purpose.

CHPs are required to have such an identification number, while small health plans (SHPs) – those with annual receipts of $5 million or less – are not.  However, SHPs may get an HPID at the direction of their CHP or if their own choosing. Moreover, CHPs are required to disclose their HPID when asked. CHPs must also disclose any changes to their required data elements in the HPID Enumeration System within 30 days of the change.

SHPs have until Nov. 5, 2015 to comply with the HPID regulation from CMS, while other health plans need to be compliant by Nov. 5, 2014. Additionally, Nov. 7, 2016 is the full implantation date for using HPID in standard transactions for both types of health plans, according to CMS.

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  • HPID history

    The Department of Health & Human Services (HHS) first published a proposed rule for HPID on April 17, 2012.

    The proposed rule “establishes a unique health plan identifier (HPID) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards for electronic health care transactions,” CMS explained on its website. “The rule also proposes a data element that will serve as an ‘other entity’ identifier (OEID) for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions.”

    On Sept. 5, 2012, the final HPID rule was announced by HHS Secretary Kathleen Sebelius. The final rule was expected to save time and money for physicians and other health care providers through the establishment of an HPID.

    Learning about HPID

    CMS held free, informational webinars one month after the HPID final rule was announced. Due to the high number of industry participants, CMS announced that it would hold monthly webinars starting in Nov. 2012. The webinars were designed to educate individuals and organizations about the HPID/OEID policy and HPOES.

    Currently, CMS has videos available on its website that explain the application process to obtain an HPID for a CHP, an SHP, and an OEID.