Health Plan Identifiers Proposed for Insurers

Although the ICD-10 compliance delay grabbed most the headlines, the proposed rule in which the ICD-10 delay was nestled also calls for standardized health plan identifiers. 

In the proposed rule released April 9, 2012, which offered a delay of ICD-10 compliance until October 1, 2014, the Department of Health and Human Services (HHS) also announced its intention to require the use of health plan identifiers (HPID). 

The change, proposed as part of the Affordable Care Act, would standardize the identifier health plans and other third party administrators use when processing claims within the healthcare industry.
Currently, there is no uniformity in identifiers used by health plans.

Plans commonly use employee identifier numbers (EIN) and tax identifier numbers (TIN) in electronic claims transactions, as well as other proprietary numbers. The establishment of the HPID will set a common standard that would simplify administrative processes and, according to language in the proposed rule, save as much as $4.6 billion over the next 10 years.

The rule states that the HPID simplify operations for providers, and that the initial cost to implement the change will be directed at the health plan insurers.

HHS has proposed two types of identifiers:  controlling health plans (CHP) and sub-health plan (SHP), that will consist of 10 unique numeric digits.

Pre-implementation work on the identifiers has been conducted since 2010 by government bodies such as the National Committee on Vital and Health Statistics, the Workgroup for Electronic Data Interchange (WEDI), and other organizations.

The HPID will have several unique uses that directly affect HIM professionals. These identifiers will be part of the patient medical record for identifying healthcare benefits, contained in Health Information Exchanges, and used in public health reporting requirements.

Click here for more details on the HPID and other identifier information.

Other objectives featured in ACA that are expected to soon be released by HHS, according to the HPID proposed rule, include more measures to reduce administrative costs, final rules from the HITECH Act that will update HIPAA law, actions to ameliorate reporting problems relating to Medicare Part D plans, and rules increasing the use of electronic transactions.

Wendy Zumar, MA, RHIA, CCS, ( is an independent terminology and coding consultant based in Aurora, CO.


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