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The Health Insurance Portability and Accountability Act (HIPAA) required the Department of Health and Human Services (HHS) to adopt standards for certain transactions to promote the efficient exchange and uniform transmission of health information. One of the standards required under HIPAA is a unique identifier for health plans. The health care reform law requires HHS to implement a standard for health plan identifiers by Oct. 1, 2012.
On April 17, 2012, the Department of Health and Human Services (HHS) issued a proposed rule to establish a unique health plan identifier under HIPAA and make some related changes. According to HHS, the effective date of the rule will be Oct. 1, 2012 when it is finalized.
health plan identifier
Currently, health plans are identified in HIPAA standard transactions using multiple identifiers that differ in length and format. Because there is not a standard identifier for health plans, health care providers experience problems with routing transactions, transactions being rejected due to insurance identification errors and difficultly determining patient eligibility.
Under the proposed rule, the standard identifier for health plans would be a ten-digit, all numeric code similar to a credit card number. According to HHS, the health plan identifier will mainly benefit health care providers, while health plans will bear most of the costs of implementing the standard.
Covered entities, except small health plans, would be required to be in compliance with the health plan identifier on Oct. 1, 2014. Small health plans (those with those with annual gross receipts of $5 million or less) would have an additional year to comply, until Oct. 1, 2015.
The proposed rule would adopt a data element that would serve as an identifier for certain entities that are not health plans, health care providers or individuals, but that perform health plan functions and need to be identified in a standard transaction. This would include, for example, health care clearinghouses, third party administrators (TPAs) or repricers.
The proposed rule would also add to the rules for the health care provider identifier by requiring certain providers not covered by HIPAA’s standard transaction requirements to obtain and disclose an identifier if they write prescriptions. Health care providers would have 180 days from the Oct. 1, 2012 effective date to comply with this additional requirement.
In addition, the proposed rule would delay the deadline for covered entities to comply with the updated set of diagnosis and procedure codes known as the International Classification of Diseases, 10th Edition (ICD-10) by one year, from Oct. 1, 2013 until Oct. 1, 2014. According to HHS, the extra year would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments.