Health Plan Identifiers Hold Little Value for Stakeholders, Poll Finds

September 25, 2014 in News

Health plans and other stakeholders see “little to no value” in using unique health plan identifiers for electronic transactions, according to a survey conducted by the Workgroup for Electronic Data Interchange, Health Data Management reports.


According to CMS, HPIDs are standard identifiers that the original 1996 HIPAA law required.

In 2012, HHS issued a final rule that requires health plans to obtain HPIDs by Nov. 5, 2014, with the exception of small health plans, which have until Nov. 5, 2015. All covered entities must use HPIDs in standard transactions by Nov. 7, 2016, according to the final rule.

CMS by 2016 intends to create a database of all health plans that use HPIDs (Slabodkin, Health Data Management, 9/23).

Survey Findings

The survey, conducted between Aug. 20 and Sept. 5, polled 262 stakeholders, including:

  • Clearinghouses;
  • Health plans;
  • Providers;
  • Software providers; and
  • Third-party administrators (Hall, FierceHealthIT, 9/23).

Overall, the survey found very low support for HPIDs. Specifically:

  • 64% of respondents said HPIDs have no value within transactions;
  • 21% said they were unsure if HPIDs have value within transactions; and
  • 15% said HPIDs have some value within transactions (Health Data Management, 9/23).

In addition, the survey found:

  • 55% of respondents said implementing HPIDs would be comparable or more complex than the National Provider Identifier registry;
  • 33% said they could not estimate how much implementation would cost; and
  • 24% reported no implementation concerns.

WEDI President and CEO Devin Jopp said the results demonstrate the lack of industry support for HPIDs and a need for CMS to change the rule (FierceHealthIT, 9/23).

In a letter sent Sept. 19, WEDI urged HHS Secretary Sylvia Mathews Burwell to reconsider WEDI’s 2013 recommendation that CMS modify the rule so that transactions would no longer require HPDIs.

WEDI Chair Jim Daley said, “The industry understands the intent of the original HIPAA statute was to solve routing issues that existed more than 15 years ago, however, the industry has resolved those issues, with special attention to privacy and security risk mitigation.” Daley also raised concerns that enumerating health plans would divert federal funding away from initiatives aimed at improving care quality and patient safety and reducing costs (Health Data Management, 9/23).


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