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HPIDs For Self-Insured Medical Plans:

What Do I Have To Do and By When?

Darcy L. Hitesman, Esq.

763-503-6620www.HitesmanLaw.com

Presented By

October 16, 2014

Health Plan Identifier (HPID)

2

HIPAA Privacy

HIPAA Security

PHIePHI

EDI*

*HIPAA Electronic Data Interchange

HPID

• A unique 10 digit number that identifies the health plan.

Remember: For HIPAA Privacy and Security purposes, a “health plan” is a “covered entity”.

• Furthers objective of standardization.

• HPID is to be used when the health plan conducts HIPAA standard transactions.

Note: Includes where a TPA or other third party conducts the transaction on the health plan’s behalf.Important: Not relieved of responsibility just because health plan does not conduct any HIPAA standard transactions. Still have to get the HPID. Just may never be required to use it.

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Plans that must obtain an HPID

• “Health plan” defined very broadlyRemember: Way back to the HIPAA Privacy and Security analyses you did.– Includes self-insured health plans sponsored by

employers for the benefit of their employees and families.

– “Self-insured” means not insured; not provided through an insurance policy• May include EAPs, wellness, on-site medical facilities

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Bundled Benefits

• To the extent a bundled or wrap plan includes component benefits that if looked at in isolation would be “health plans,” view the component benefits as if provided on a stand-alone basis.

Note: This is consistent with the way other portions of the HIPAA Privacy and Security requirements are addressed.

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Bundled Benefits• For example, a wrap plan includes group medical insured

coverage, self-insured dental coverage and an HRA that provides more than just cost share amounts under the group medical plan could have three HPIDs. The insurance carrier would handle the HPID with respect to the insured group medical coverage. The self-insured dental plan and the HRA would each be self-insured, not otherwise exempted from the HPID requirement, and required to obtain either their own HPIDs or an HPID for the two combined.

Action Item: List self-insured health plans, err on the side of over-including.

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HSAs, Health FSAs, and HRAs• Recent FAQs issued by CMS

– “Confirm” HSAs and Health FSAs are individual accounts directed by the individual and, therefore, do not need HPIDs.

• In general, HRAs require HPIDs if the HRA is a health plan.– HRAs that cover only deductibles or out of pocket maximum costs do

not need an HPID; viewed as additional benefits of major medical– Stand alone HRAs require HPIDs.

Remember: Whether a particular health plan actually conducts transactions electronically does not matter.Action Item: Identify HSAs, Health FSAs, and HRAs that do not need HPIDs.

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Obtaining the HPID

• FAQs place legal responsibility to obtain HPID on the health plan; not the TPA, broker, consultant, or other business associate.

• Health plan can authorize TPA to obtain HPID on behalf of health plan but the HPID belongs to the plan.

Warning: Do not assume someone else is doing it for you!Action Item: Identify the plan administrator of each self-insured health plan. Identify the TPA, if any, of each self-insured health plan.

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Obtaining the HPID• Size of each health plan determines the deadline(s) for

obtaining HPID(s)• “Small” health plans must obtain an HPID by November 5,

2015.– Annual receipts of $5 million or less– For a self-insured health plan, look at the benefits paid out of the

health plan; not tied to COBRA rates or premium equivalents; does not matter whether health plan is funded, unfunded, or a combination

– Not small health plans must obtain an HPID by November 5, 2014– If small, not required to wait until next year.

Action Item: Identify the size of each self-insured health plan on the list.

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Obtaining the HPID

• Must apply online– http://portal.cms.gov

• HPID User Manual. Describes step by step process of obtaining the HPID through the CMS website.– http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative

-Simplification/Affordable-Care-Act/Downloads/HPIDQuickGuideOctober2014508Accessible.pdf.

Special Note: Where asked to provide an NAIC number or Payer ID, most employer-sponsored self-insured health plans should answer “not applicable” because they do not have these numbers.

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Using the HPID• Beginning November 7, 2016, all health plans (regardless of

size) must use HPIDs when conducting HIPAA standard transactions.

• Can also use HPID for other purposes.• HIPAA Standard transactions include those involving claims

and encounter information, enrollment and disenrollment information, premium payment information, claims status information, and information regarding referrals and authorizations.

Remember: Fact that health plan does not conduct any HIPAA standard transactions, does not impact requirement that health plan has to get one.

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Action Item Summary List all self-insured health plans.

Break down bundled plans into components Err on the side of over including

Identify HSAs, Health FSAs, and HRAs that do not need HPIDs. Identify the size of each self-insured health plan. Identify the plan administrator of each self-insured health

plan. Identify the TPA, if any, of each self-insured health plan. Determine if and when to apply for HPID(s). Determine who is going to obtain HPID(s).

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Questions

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Thank you• Darcy L. Hitesman

Hitesman & Wold, P.A.12900 – 63rd Avenue NorthMaple Grove, MN 55369763-503-6620

Visit our website to register to receive our informational Client Alerts! www.HitesmanLaw.com

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