KNOW WHO YOU ARE WORKING WITH Encourage Your Health Plans, Preferred Provider Networks (PPNs), and Third Party Administrators (TPAs) to Get and Use Their Organizations’ New, Free “Health Plan Or Other Entity” Identifier! Published with permission of the American Medical Association (AMA) the american medical association (ama) was instrumental in the push to adopt a health Plan identifier (hPid) for each payor and entity involved in the healthcare billing and payment process, so that billing companies and physician practices will know who they are actually working with. the u.s. department of health and human services (hhs) “administrative simplification: adoption of a standard for a unique health Plan identifier (hPid)” rule provides an invaluable opportunity to eliminate the ambiguity that makes healthcare transactions so costly today. this ambiguity stems from the fact that the term “health plan” can mean a host of different things, ranging from the actual health insurance product an individual buys to the company that sells that product, and includes each of the intermediaries involved in the multitude of transactions which occur during the administration of our third-party payment system. the adoption of a robust hPid and other entity identifier (oeid) eliminates this ambiguity, thus reducing costs dramatically for all the trading partners. health plans and all their business partners (third-party administrators tPas, benefit and disease management companies, preferred provider networks PPns, etc.) can now apply for a standard identifier for their organizations. this will eliminate the uncertainty as to trading partner identities that currently plagues the health care industry and undermines automation efforts. health plans must secure their hPid by november 5, 2014 (small health plans by november 5, 2015). hhs will be providing more information regarding the application process through its health insurance oversight system (hios). the “administrative simplification: adoption of a standard for a unique health Plan identifier (cms-0040-P)” final rule by the centers for medicare & medicaid services, available at https://federalregister.gov/a/2012-21238, was published in the federal register on september 5, 2012. this final rule adopts the standard for a national unique hPid and establishes requirements for its implementation. the rule authorizes, but does not require, all entities that play health plan roles, including tPas, benefit and disease management companies, and PPns, to obtain an oeid. Share Information About HPID/OEIDs with Your Business Associates! Please encourage your health plans, PPns, and tPas to obtain a specific hPid/oeid for each of their companies as appropriate. the reduction of administrative costs, such as phone calls and appeals, that the hPid/oeid promises will only occur if each of your business associates obtains an appropriate identifier and prepares to utilize these ids in the hiPaa electronic health care transactions no later than november 7, 2016. Visit www.ama-assn.org/go/simplify to access a flyer about hPid/oeid to give to your PPns and tPas. Reduce Administrative Costs (e.g., phone calls) Through Increased Transparency the hPid/oeid is the first step toward achieving a fully automated claims payment and reconciliation cycle, which will require that all relevant information concerning the payor, the payor’s agents, and the fee schedule amount be transmitted on all relevant electronic healthcare transactions in unambiguous terms. given the plethora of potential claims, billing, and payment scenarios – including the added complexity of numerous organizations performing health plan roles (payor, administrator, network contractor, etc.) – payment transparency and accuracy can only occur if the following information is clearly identified on each of the hiPaa mandated electronic health care transactions, such as the accredited standards committee (asc) X12 5010 271 eligibility and 835 electronic remittance advice: 1. the entity financially responsible for payment 2. the entity responsible for administering the claim 32 hbma billing • march.aPril.2013
Billing_MA13
To see the actual publication please follow the link above