MGMA calls for more granular health plan identifiers

The Medical Group Management Association (MGMA) has raised questions about the way the Centers for Medicare and Medicaid Services (CMS) is approaching its implementation of health plan identification numbers (HPIDs). In the same letter that MGMA sent the agency last week requesting changes in ICD-10 implementation, the association of group practice administrators asked CMS to provide more granular identification of all entities that fund, receive and administer claims.

In addition, MGMA wants CMS to recalculate its cost-benefit analysis of the HPID provision, conduct a pilot test of the HPID prior to implementation, work with the industry to create feasible timelines, and require all health plans to obtain HPIDs prior to the compliance date. Right now that date is Oct. 1, 2014--the same as for ICD-10 compliance--and MGMA would like the deadlines to be staggered instead.

MGMA offers several reasons for increasing the granularity of the HPID. Under the current proposal, for example, each health plan would receive a single identifier; but, as the association points out, health plans offer multiple products, only some of which particular providers contract with. So enumerating at the health plan level wouldn't help streamline physicians' revenue cycle management process.

CMS has claimed that the HPID would save the industry between $1 billion and $4.6 billion, partly from a reduction in pended claims. However, MGMA said, "the cost data is not reflective of provider reality in terms of efficiency gained and the resulting cost savings" if CMS issues only one HPID per health plan. In addition, the association notes, the Committee on Operating Rules for Information Exchange (CORE) of the Council for Affordable Quality Healthcare has already issued rules for verifying insurance eligibility that will reduce the number of pended claims.

Ironically, CMS adopted the CORE rules for eligibility and claims status last year, giving health plans, clearinghouses and providers until 2013 to implement them.

MGMA also made a strong pitch for payers issuing machine-readable patient ID cards that would contain the HPID. Carrying on a crusade that the MGMA launched in 2009 with its SWIPE IT campaign, the association recommended to CMS that:


  • Medicare issue machine-readable ID cards to all Medicare beneficiaries
  • Health plan ID cards be required to follow a particular format of the Workgroup for Electronic Data Interchange (WEDI)
  • No additional security be required for providers to use patient ID cards to initiate online eligibility inquiries

To learn more:
- read the MGMA letter (pdf)

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