The HR Legal News Blog

Health Plan Identification Numbers (HPID): Large Group Health Plans Must be Obtained by November, 2014

Health Plan Identification Numbers Required by November 2014

Self-insured group health plans are required to obtain health plan identification numbers (HPID).  Health Plan Identification Numbers are required for each “controlling health plan” or CHP and may be used by a “subhealth plan” (SHP).  Under 45 CFR 162.103, a CHP is a plan that (i) controls its own business activities, actions or policies or (ii) is controlled by an entity that is not a health plan and, if it has an SHP, exercises sufficient control over the SHP to direct its business activities, actions or policies.  An SHP is a health plan whose business activities, actions or policies are directed by a CHP.  Most self-insured group health plans are likely to qualify as controlling health plans.

If all goes as planned, the use of standardized HPIDs will help health care providers to determine eligibility, process bills and perform other insurance-related tasks more efficiently by increasing automation and decreasing the time spent on interactions with health plans.   In addition to requiring business associates to refer to the HPID when performing certain tasks for a covered entity, the Department of Health and Human Services suggests that the HPID could be used by health plans on internal files and health insurance cards in order to facilitate the smooth processing of claims and detect fraud and abuse.

The deadline for large plans (those with annual cost of $5 million ore more) to apply for an HPID is November 5, 2014.  Small group health plans must apply for an HPID by November 5, 2015.