The proposed rule, part of the Patient Protection and Affordable Care Act, would also add an element, an “other entity” identifier, for groups that are not health plans, healthcare providers or individuals but need to be identified in transactions.
HHS said the adoption of HPID and OEID would increase standardization within HIPAA standard transactions and would eliminate problems that several hospitals and healthcare providers experience frequently, such as improper routing of transactions, rejected transactions due to insurance identification errors, difficulty in determining patient eligibility and other claims processing challenges.
Other elements of the proposed rule include:
• The proposed HPID and OEID add on to HHS’ final rule from January 2004, which established the National Provider Identifier as a claims standard for healthcare providers.
• “Controlling health plans,” or health plans that control their own business activities, would be required to obtain an HPID.
• “Subhealth plans,” or health plans whose business activities are directed by a CHP would not be required to obtain an HPID but may choose to obtain an HPID, or its controlling health plan could obtain an HPID on the subhealth plan’s behalf.
• An HPID would be used in any and all HIPAA-covered transactions and other purposes that require identification of health plans, such as using an HPID on a health insurance card.
• The proposed standard for the HPID would be similar to the NPI, which is a 10-position, all-numeric identifier with a numeric check digit to assist in identifying erroneous or invalid NPIs.
• OEIDs would have a different start digit than HPIDs to distinguish between the two overarching groups of healthcare entities.
In a news release, HHS Secretary Kathleen Sebelius said the proposed changes could save healthcare providers and health plans up to $4.6 billion over the next decade. The proposed rule is open for public comment until May 17.
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