HPID: Is There an Alternative Solution?

by Victor Laguardia

As written in previous blog posts, HPID is a major upcoming initiative that is coming down the health IT pike.  However, there is considerable confusion and competing understandings of how this should be implemented.  In this article, the clearinghouse Emdeon has proposed an alternative solution to HPID.  In fact, this solution is not new and first surfaced from Emdeon last year.  There was an industry-wide call setup by the Cooperative Exchange last month where different healthcare entities from clearinghouses, payers, and providers discussed this alternative solution.

Emdeon Alternative Solution–What Is It???

Emdeon presented to WEDI an alternative solution to the use of HPID on the 5010 transactions. This alternative is meant to be only meant as a recommendation to CMS and not indicative that Emdeon will not implement HPID. Following is a summary of their recommendation:

  • Leave Payer information as it is today.
  • Remove all references to HPID from the TR3 Payer Information Segments of 5010 transactions.
  • Use the REF for Subscriber additional information to carry Health Plan ID associated with the claim.
  • In the 271 (Health Plan Eligibility Response) 2100 Subscriber Additional Identification Segment REF01 value ‘18’ Plan Number, add a code note to indicate the Plan Number is the HPID.

Emdeon’s approach would only use the HPID in the eligibility response and look at the ABY qualifier (Centers for Medicare and Medicaid Services Plan ID) for future versions.  The change came about from conversations with ASC X12 who felt that the ABY in the REF01 Element would require Errata (The Errata is created by ASC X12 to resolve impediments to implementation identified after the publication of the TR3s) and would be much more invasive.

WEDI’s Recommendation

WEDI, as an industry organization, has been real careful not to explicitly endorse Emdeon’s alternative HPID solution.  However, WEDI informs CMS of major dialogue and discussions that are occurring in regards to major health IT initiatives.  WEDI communicated to CMS this alternative HPID solution back in October of 2013.  WEDI will forward this alternative solution again to CMS at behalf of the HPID industry workgroup.  This, however, still does not constitute a WEDI endorsement of this HPID alternative solution.

Leave a Reply

Your email address will not be published. Required fields are marked *