Requirement to Obtain Health Plan Identifier Delayed

The Centers for Medicare and Medicaid Services (CMS) has delayed the requirement for health plans to obtain a health plan identifier and use it for certain transactions.

Effective October 31, 2014, the rules for obtaining a health plan identifier (HPID) and using them in any Health Insurance Portability and Accountability Act (HIPAA) standard transactions that the health plan conducts or that a business associate conducts on behalf of the health plan are delayed until further notice. The CMS says this applies to all HIPAA-covered entities, including healthcare providers, health plans, and healthcare clearinghouses.

The CMS noted in its announcement that the National Committee on Vital and Health Statistics (NCVHS), an advisory body to the Department of Health and Human Services (HHS), recommended that HHS rectify in rulemaking that all covered entities not use the HPID in the HIPAA transactions. In its report, the NCVHS brought up issues of confusion and cost to entities from the HPID rule. It also noted that the industry’s move to the implementation of a standardized national payer identifier already addresses the intent of the requirement to obtain and use an HPID.

CMS said the delay in enforcement of the HPID rule will allow HHS to review the NCVHS’s recommendation and consider any appropriate next steps.

Plan sponsors of self-insured health plans were required to obtain an HPID number no later than November 5, 2014. The requirement had already been delayed to November 5, 2015, for small plans with annual receipts of $5 million or less.

The CMS announcement is here