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Final Regulations Rescind HIPAA Health Plan Identifier Rules

On Behalf of | Nov 6, 2019 |

The Department of Health and Human Services (“HHS”) has rescinded earlier regulations governing the health plan identifiers (“HPIDs”) that group health plans were required to obtain and use in standard electronic transmissions as specified in the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).

Background. The HPID is a unique 10-digit number that identifies a group health plan when it engages in standard transactions. HIPAA requires HHS to establish uniform standards for electronic transactions between group health plans and health care providers such as doctors, pharmacies, and hospitals. The Affordable Care Act subsequently directed HHS to issue final regulations establishing HPIDs.

On September 5, 2012, HHS issued final regulations that: (i) adopted a unique standard HPID for use in HIPAA electronic transactions; and (ii) included an “other entity identifier” (“OEID”) for non-health plan entities (e.g., third party administrators).

Following publication of the final rules, HHS received significant negative feedback from covered entities and other stakeholders regarding the burdens, implementation costs, and inefficiencies created by the HPID rules. In response, on October 31, 2014, HHS announced that covered entities would not be penalized for non-compliance with the HPID final rule.

On December 18, 2018, HHS published a proposed rule to rescind the HPID and OEID requirements based on additional input from industry stakeholders. The rule was adopted as proposed after HHS received supporting comments in response to it from stakeholders.

Final Rule. HHS’s final rule eliminates the regulatory requirement for health plans to obtain and use HPIDs, and eliminates the voluntary acquisition and use of the OEID.

The final rule also simplifies the process for deactivating the existing identifiers to minimize operational costs for covered entities. On or after the effective date of the final rule, any active HPID or OEID will be automatically deactivated by HHS in the Health Plan and Other Entity Enumeration System. HHS will update the CMS website with information about deactivation activities and a related timeline.

The final rule, which is effective December 27, 2019, is available by clicking here.