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Health Plan Identifier

The Department of Health and Human Services (HHS) has released a Request for Information (RFI) on the Health Plan Identifier (HPID).  In the RFI, HHS is asking representatives from health plans, covered health care providers, and health care clearinghouses, to respond to three questions, and to offer any other insight on the use of an identifier in electronic transactions.  The questions in the Request for Information cover the enumeration structure; terminology used for the enumerated entities (controlling health plans, subhealth plans and other entities); use of both the HPID and Payer ID in the transactions; and how the evolving trends in health care have changed the perspective on the purpose of the HPID.  The Secretary of HHS and staff of the National Standards Group is encouraging the submission of comments from all industry sectors.  For more information, visit the Latest News page.

Background

The Health Plan Identifier (HPID) is a standard identifier for health plans, which was required to be adopted under the Health Insurance Portability & Accountability Act of 1996 (HIPAA).   On September 5, 2012, the Department of Health and Human Services (HHS) published a final rule (CMS-0040F) adopting this unique identifier (HPID) for Health Plans.  A definition for health plans can be found in the final rule for Transactions and Codes Sets at 45 CFR 160.103.  In that rule, there are further references to the US Code 42 U.S. Code § 300gg–91.  

HPID Enumeration 

Enumeration is the process of getting an HPID.  All Controlling Health Plans (CHPs) must enumerate.   Third-party administrators are not eligible to obtain HPIDs for themselves, but may submit HPID requests in the Health Plan and Other Entity Enumeration System (HPOES) on behalf of their health plan customers. View the data elements that will be collected for HPID (CHP and SHP) and OEID applications and the subhealth plan category definitions.

How to apply for a Health Plan (HPID) and Other Entity Identifier (OEID)?

HPIDs and OEIDs can be obtained through the Health Plan and Other Entity Enumeration System (HPOES). HPOES is housed within the CMS Health Insurance Oversight System (HIOS).

To apply for an HPID or OEID, follow these steps:

  • First, you must create an account in the CMS Enterprise Portal to obtain a user ID and password.  This is a separate process and system which will verify the user’s identity and ensure that only authorized/registered users will access protected information and systems.
  • Second, select the link to register in the HIOS.  Registering in HIOS may take up to 48 hours to complete as it involves a manual review of submitted information.
  • After registering in HIOS, select the HPOES, and follow the prompts.  If you have any system related questions, please contact the Exchange Operations Center at phone: 1-855-267-1515 or Email: CMS_FEPS@cms.hhs.gov.

If you need help getting an HPID

There is an HPID User Manual (10, 092 KB) and a Quick Guide available.  The user manual explains the user functionality of the HPOES module within the Health Insurance Oversight System (HIOS).  This manual provides step-by-step instructions for the features and functionalities available in HPOES.  

The Quick Guide provides an easy step-by-step reference for registering in the CMS IT system and accessing HPOES.  You can view the Quick Guide in graphic or text form. 

Enforcement Discretion

Effective October 31, 2014, the Centers for Medicare & Medicaid Services (CMS), announced a delay, until further notice, in enforcement of regulations for obtaining and using HPIDs in HIPAA transactions adopted in the HPID final rule(CMS-0040-F).  For more information, visit the Latest News page.

Questions about the HPID

HPID Frequently Asked Questions (FAQs)-HPID FAQs are posted on the CMS website and continue to be updated as new information is available.  

HPID Mailbox -If you have policy questions about HPIDs and OEIDs, you can contact CMS through the HPID Mailbox at HPIDquestions@noblis.org.