Among the 2500 pages of PPACA (better known as health care reform), there are the BIG THINGS and NOT SO big things. The Administrative Simplification rules and guidelines are among the “Not So big things” category however, like most of the changes, you need to know what it is and who they affect.
What Is This Regulation?
These rules and guidelines are intended to create uniformity in electronics transfers of data that SHOULD make the health care system more efficient; less administrative burden for all parties, mainly between insurers, health care professionals, banks and financial institutions. In a nutshell, it should improve claims payment efficiency and improve transparency as it relates to cash flow.
Who Does Will It Impact & Who Needs To Comply?
First of all, it will impact the players mentioned above and self funded group plans. Health plans (carriers) will be required to have a Health Plan Identifier (HPID) which is designed to streamline the electronic transactions process between plans, administrators, health care professionals and financial institutions. From what has been interpreted thus far, it looks like this will be up to the carriers to obtain for all covered entities and true, self-insured group plans. Health plans and other organizations can access the Health Plan and Other Entity Enumeration System to create their own account and the HHS will use this system to assign HDIP’s. Self insured group plans are encouraged to visit the Centers for Medicare and Medicaid Services site for more information and to basically get on their email update list. Once on their site, you will want to access their educational and training materials before applying for your HDIP. Once registered, you will begin getting updates until fully implemented.
Premium Payments and Enrollment/Disenrollment
These particular requirements are still being developed (like most of HCR), it is expected that operating rules for electronic payments and enrollment processing will go into effect January 1, 2016. Although groups will be affected in these two areas, at this point in time, it is not certain to what extent.
