Hospital Group Opposes Using Health Plan Identifiers on Claims

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By James Swann

July 21 — A hospital association urged the CMS to block the use of health plan identifiers (HPIDs) on claims transactions, contending that their use would overly burden providers, according to a July 20 comment letter.

The American Hospital Association letter was in response to a notice published in May by the Centers for Medicare & Medicaid Services requesting comments on whether HPID use should be revised in light of the changes that have been made to the health-care system since 2012.

The deadline for comments is July 28.

The CMS published a final rule in September 2012 requiring health plans to obtain a unique, 10-digit HPID, and requiring Health Insurance Portability and Accountability Act-covered entities to include the HPID in HIPAA transactions starting Nov. 7, 2016.

While the CMS rule doesn't require HIPAA-covered entities to identify health plans in HIPAA transactions, covered entities must use the HPID if they want to identify a health plan.

The hospital association said providers have developed alternative approaches to ensure that their claims are getting to the correct health plans, and that “a requirement to use a new HPID in the HIPAA transactions would create disruption and confusion to the existing system that routes claims.”

HPIDs have also proliferated since 2012, with some health plans having over 60 HPIDs, according to the AHA, which would add to provider burdens.

“The intent of the HIPAA legislation was to reduce administrative costs and make the process more efficient; the adoption of the HPID within the HIPAA transaction standards does neither,” the letter said.

Alternative HPID Uses

While opposed to the use of the HPID in HIPAA transactions, the letter offered several instances where its use would be appropriate.

The CMS could use the HPID to determine whether a health plan is a covered entity under HIPAA or whether a plan is certified to participate in the Affordable Care Act's federally facilitated insurance marketplace, the letter said.

The CMS could use the HPID to determine whether a health plan is a covered entity under HIPAA, for example, or whether a plan is certified to participate in the Affordable Care Act's federally facilitated insurance marketplace, the letter said.

The letter said the CMS should begin using the HPID for certification purposes no later than December.

“Health plan certification is important because it would help identify which health plans are in compliance with the transaction standards, as well as identify health plans that are compliant with the operating rules in the future,” the letter said.

To contact the reporter on this story: James Swann in Washington at jswann1@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com