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HIPAA Health Plan Identifiers Delayed Until Further Notice

The CMS introduced the rule that a national health plan identifier must be used for transactions, yet it appears to have had second thoughts on the issue and its HPID plans have now been “delayed until further notice”.
The Office of E-Health Standards and Services of the CMS previously ruled in 2012 that it would require health plans to have a numerical identifier, while other covered entities would also be required to use them and would be covered in future mandates.
The Health Insurance Portability and Accountability Act of 1996 uses HPIDs along with other identifiers to simplify administration. HIPAA provider IDs were first introduced in 2007, although plans for the introduction of a national patient identifier have been on hold since 2000 due to privacy and security concerns.
The use of health plan identification numbers has not been met with praise by all in the healthcare industry and concern has been voiced that the use of these identifiers would just add granularity; over-complicating transactions unnecessarily. The purpose of HPIDs has also been questioned, in particular for the transaction part of the process which industry experts consider to be unnecessary.
The HIPAA official adviser to HHS, the National Committee on Vital and Health Statistics (NCHS), recommended to the CMS in September this year that it would be advisable to abandon the introduction of a HPID as an alternative enumeration scheme was already being used privately. Since the main aim of HPIDs was to make routing transactions to appropriate payer recipients a simple process, it makes sense to use a system which is already proving to be effective.
Standardized payer identifiers are already in use in private healthcare. These are based on The National Association of Insurance Commissioners’ identifier and the identifiers are used on a daily basis. In a communication to HHS Secretary Sylvia Matthews Burwell, NCHS states that the identifiers are “widely used and integrated into all provider, payer and clearinghouse systems.”Since these identifiers are in use on a daily basis, making changes would cause major disruption to all administrative transactions.”
The CMS announcement comes shortly before the November 5th deadline for health plans to obtain a HIPD. Use of HPIDs was due to be enforced on Nov 7, 2016.

Author: Steve Alder is the editor-in-chief of HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has several years of experience writing about HIPAA and other related legal topics. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics.