Officials at the U.S. Department of Health and Human Services (HHS) are hoping they can start giving health plans Health Plan Identifier (HPID) numbers Oct. 1.
HHS officials describe their vision of the HPID system in proposed HPID regulations that are on track to appear in the Federal Register April 17.
In the same document, HHS officials have proposed postponing the date when U.S. health care organizations must shift to using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), from the ICD-9 system to Oct. 1, 2014, from Oct. 1, 2013.
HHS developed the HPID regulations to implement Section 1104 of the Patient Protection and Affordable Care Act of 2010 (PPACA), which requires HHS to set up a standard unique health plan identifier system.
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The Supreme Court is weighing the constitutionality of PPACA, and PPACA opponents are working in Congress to try to get the law repealed. The HPID project could survive even if the rest of PPACA dies because the HPID project is a sister to other HHS identification number projects spawned by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
HHS created a HIPAA-related unique employer identifier in 2002 and a HIPAA-related National Provider Identifier (NPI) system in 2004.
Health plans still use several types of identification codes, including taxpayer identification numbers, employer identification numbers (EINs), proprietary codes, and identification numbers provided by the National Association of Insurance Commissioners (NAIC), Kansas City, Mo.
“Not only are health plans identified using a variety of identifiers, but these identifiers have different formats,” officials say in a preamble to the proposed regulations. “For instance, some identifiers are alphanumeric, while other identifiers are only numeric. Identifiers also differ in length; for example, NAIC codes are typically 5 digits while an EIN is 9 digits.”
Because of the lack of a standardized plan ID system, doctors and hospitals face problems such as “rejected transactions due to insurance identification errors, difficulty in determining patient eligibility, and challenges resulting from errors in identifying the correct health plan during claims processing,” officials say.
PPACA Section 1104 requires HHS to make an HPID system rule effective by Oct. 1, 2012.
Some public commenters told an advisory panel helping HHS develop the HPID system, the National Committee on Vital and Health Statistics (NCVHS), that they would like to see plans get ID numbers at the parent company level. In that system, XYZ Insurance Company would get an ID number, but its Deluxe Porsche Plan and its Bargain Hunter’s Delight Plan would not.
Other commenters asked HHS to create two types of ID codes: One code system for health plans, and second code system for other types of health care organizations, such as long-term care insurance (LTCI) plans and “third party administrators” (TPAs), or independent plan administrators.
Some commenters wanted the ID system to be specific enough that the provider could use the code to look up the fee schedule for a plan a patient was using.
Carriers and others argued that building product-level information into the HPID would make the HPID system too complicated and expensive, officials say.