Health Plan Identifier Requirements

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The Department of Health and Human Services (HHS) requires all health plans to obtain a ten-digit "unique identifier" from a government sponsored agency. Plans must use a Health Plan Identifier (HPID) to identify a health plan in standard Health Insurance Portability & Accountability Act (HIPPA) electronic transactions.

Plans that are fully insured on the medical and self-funded on their pharmacy benefit are required to apply for an HPID.

Key compliance dates to obtain the HPID are as follows:

• Health plans, with the exception of small health plans, must obtain HPIDs by November 5, 2014.
• Small health plans (annual receipts of $5 million or less) must obtain HPIDs by November 5, 2015.
• All plans that generate electronic transactions are required to use the identifier in those transactions beginning November 7, 2016.

The online application is available through the Health Plan and Other Entity Enumeration System (HPOES) housed within CMS' Health Insurance Oversight System (HIOS) and may be accessed through the CMS Enterprise Portal. Users will need to provide additional information to register in the enterprise portal and obtain a user ID and password.

The application also requests a Payer ID or National Association of Insurance Commissioners (NAIC) number. CMS has advised that self-funded employers who do not have these numbers may enter "not applicable" in this field on the application.

To learn more about the application process, you may view CMS' HPID and OEID overview presentation by clicking here. In addition, videos are available to walk through each step of the application process to obtain a HPID for a controlling health plan, a sub health plan and other entity identifier. See Quick Reference Guide to: Obtaining a Controlling Health Plan HPID.

For more information, please contact PBIRx at (888) 797-2479 today!