HHS Publishes NPRM for HIPAA Health Plan Identifier and Delay for ICD-10 Compliance Date

April 17, 2012.  The Office of the Secretary of the Department of Health and Human Services (HHS) published today in the Federal Register its Notice of Proposed Rule Making (NPRM):  Administrative Simplification:  Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10-CM and (CD-10-PCS Medical Data Code Sets.

From the NPRM is the Summary of the Major Provisions:

“a. HPID.  This rule proposes the adoption of the HPID [national unique health plan identifier] as the standard for the unique identifier for health plans and definitions for ‘Controlling Health Plan’ and ‘Subhealth Plan.’ The proposed definitions of these two terms seek to differentiate between health plan entities that would be required to obtain an HPID, and those that would be eligible, but not required, to obtain an HPID. This rule also proposes to require all covered entities to use an HPID whenever a covered entity identifies a health plan in a covered transaction.  Because health plans today have many different business structures and arrangements that affect how health plans are identified in standard transactions, these two proposed definitions also seek to enable health plans to obtain HPIDs to reflect differing business arrangements so they can be identified appropriately in standard transactions.

“This rule also proposes the adoption of a data element that would serve as an other entity identifier (OEID).  The OEID would serve as an identifier for entities that are not health plans, health care providers, or ‘individuals’ (as defined in 45 CFR 160.103), but that need to be identified in standard transactions (including, for example, third party administrators, transaction vendors, clearinghouses, and other payers). Under this proposed rule, these other entities would not be required to obtain an OEID, but they could obtain and use one if they needed to be identified in covered transactions.  Because other entities are identified in standard transactions in a similar manner as health plans, we believe that establishing a data element to serve as an identifier for these entities will increase efficiency by encouraging the use of a uniform identifier.

“The most significant benefit of the HPID and the OEID is that they will increase standardization within HIPAA standard transactions by establishing uniform identifiers.

“b.  NPI.  This rule purpose that an organization covered health care provider require certain non covered individual health care providers who are prescribers to:  (1) Obtain NPIs [National Provider Identifiers] and; (2) to the extent the prescribers write prescriptions while acting within the scope of the prescribers’ relationship with the organization, disclose them to any entity that needs the NPIs to identify the prescribers in standard transactions.  This addition to the NPI requirements would address the issue that pharmacies are encountering when the NPI of a prescribing health care provider needs to be included on a pharmacy claim, but the prescribing health care provider does not have, or has not disclosed an NPI.

“c.  ICD-10-CM and ICD-10-PCS.  This rule proposes that the compliance date for ICD-10-CM and ICD-10-PCS be changed from October 1, 2013 to October 1, 2014.  We believe this change will give covered entities the additional time needed to synchronize system and business process preparation and changeover to the updated medical data code sets.”

HHS invites comments on this NPRM, to be received no later than 5 PM on Thursday, May 17, 2012.  Instructions for submitting comments are provided in the NPRM on page 22950.

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