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Health Plan Identifier (HPID) and Other Entity Identifier (OEID)

Augmenting the Health Insurance Portability and Accountability Act (HIPAA), the Patient Protection and Affordable Care Act (also known as ACA) directed the Secretary of the Department of Health and Human Services (HHS) to issue a Final Rule establishing a standard, unique Health Plan Identifier (HPID). The purpose of a standard HPID is to uniquely identify a health plan in a uniform way in HIPAA transactions.

In order to increase the efficiency of using uniform identifiers in standard transactions, HHS also adopted a data element that will serve as an Other Entity Identifier (OEID). The OEID is intended to function as a voluntary identifier for entities that are not health plans, health care providers, or individuals (as defined in 45 CFR 160.103), but need to be identified in HIPAA standard transactions.

As a health plan entity, TRICARE will be responsible for communicating and providing TRICARE’s HPID(s) to other entities who need this information. Military treatment facilities will need to use HPIDs when conducting HIPAA transactions such as, eligibility, referrals, claims, etc. There may be other MHS uses of the HPID as well.

In October 2014, TRICARE successfully submitted for and obtained a Controlling Health Plan (CHP) HPID from the Centers for Medicare and Medicaid Services (CMS) enumeration database. On October 31, 2014, CMS announced a delay in HPID compliance enforcement while it evaluates HPID enumeration and usage. In light of the delayed enforcement of HPID enumeration and usage, the HIPAA Transactions, Code Sets and Identifiers (TCS&I) Office will continue to monitor CMS communication for future direction.

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Health Plan Identifier and Other Entity Identifier Fact Sheet

Fact Sheet
9/10/2012

This fact sheet explains the Health Plan Identifier and Other Entity Identifiers

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Health Plan Identifier and Other Entity Identifier
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