Hero _HIPAA_Transaction _Compliance

HIPAA Transaction Compliance

The Department of Health and Human Services (HHS) requires health plans to obtain a health plan identifier (HPID) by November 5, 2014 (small health plans with annual receipts of $5 million or less have until November 5, 2015 to comply). Employers that sponsor self-funded health plans will need to register for the HPID; insurance companies will perform this task on behalf of employers that sponsor fully-insured plans. An employer may register for and obtain the HPID from the HHS website. Once a health plan has received their HPID, any covered entity or business associate that identifies the health plan must utilize the assigned HPID number when conducting electronic, standard business transactions, so it will be important to share the HPID with applicable entities.

The second part of this new HIPAA requirement is to get assurance from plan administrators and vendors who process standard transactions for the plan that the vendor has gone through a required testing process and has received the necessary certification from HHS. Both large and small health plans must submit certification of their compliance with certain standard transaction rules by December 31, 2015. Note that this process can reportedly take six months or more, so health plans should start working on the certification process as soon as they receive their HPIDs.

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HIPAA Transaction Compliance Hot Topics & FAQs

  • Delay in HPID Requirement

    On October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a delay in the requirement for HIPAA covered entities, including health plans, health care providers, and health care clearinghouses to obtain a Health Plan Identifier (HPID). The HPID was required to be obtained by November 5, 2014 for health plans with annual receipts in excess of $5 million. Employers were required to obtain this ID for any self-funded plan offerings. HPIDs for insured plans were to be handled by the insurer. The delay applies until further notice. On September 23, 2014, the National Committee on Vital and Health Statistics (NCVHS), an advisory body to HHS, recommended that HIPAA covered entities not use the HPID in the HIPAA transactions. The delay will allow HHS to review the NCVHS’s recommendation and consider any appropriate next steps.

  • New Resources Available to Assist with November 5, 2014 HPID Requirement

    The Department of Health and Human Services (HHS) has published a Quick Reference Guide for obtaining a health plan identifier (HPID) under HIPAA. HHS requires health plans to obtain an HPID by November 5, 2014 (small health plans with annual receipts of $5 million or less have until November 5, 2015 to comply). Employers that sponsor self-funded health plans will need to register for this ID; insurance companies will perform this task on behalf of employers that sponsor fully-insured plans. An employer may register for and obtain the HPID from the HHS website. Once a health plan has received its HPID, any covered entity or business associate that identifies the health plan must utilize the assigned HPID number when conducting electronic, standard business transactions. So, it will be important to share the HPID with applicable entities.

    American Fidelity Administrative Services has published a new white paper to help you understand these requirements, along with the certification requirements that are due by December 31, 2015. For more information, please contact 877-302-5073.

American Fidelity Assurance Company does not provide tax or legal advice.

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