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Electronic Code of Federal Regulations

e-CFR Data is current as of September 16, 2014

Title 45Subtitle ASubchapter CPart 162 → Subpart E


Title 45: Public Welfare
PART 162—ADMINISTRATIVE REQUIREMENTS


Subpart E—Standard Unique Health Identifier for Health Plans


Contents
§162.502   [Reserved]
§162.504   Compliance requirements for the implementation of the standard unique health plan identifier.
§162.506   Standard unique health plan identifier.
§162.508   Enumeration System.
§162.510   Full implementation requirements: Covered entities.
§162.512   Implementation specifications: Health plans.
§162.514   Other entity identifier.

Source: 77 FR 54719, Sept. 5, 2012, unless otherwise noted.

§162.502   [Reserved]

§162.504   Compliance requirements for the implementation of the standard unique health plan identifier.

(a) Covered entities. A covered entity must comply with the implementation requirements in §162.510 no later than November 7, 2016.

(b) Health plans. A health plan must comply with the implementation specifications in §162.512 no later than one of the following dates:

(1) A health plan that is not a small health plan— November 5, 2014.

(2) A health plan that is a small health plan-

November 5, 2015.

[77 FR 54719, Sept. 5, 2012, as amended at 77 FR 60630, Oct. 4, 2012]

§162.506   Standard unique health plan identifier.

(a) Standard. The standard unique health plan identifier is the Health Plan Identifier (HPID) that is assigned by the Enumeration System identified in §162.508.

(b) Required and permitted uses for the HPID. (1) The HPID must be used as specified in §162.510 and §162.512.

(2) The HPID may be used for any other lawful purpose.

§162.508   Enumeration System.

The Enumeration System must do all of the following:

(a) Assign a single, unique—

(1) HPID to a health plan, provided that the Secretary has sufficient information to permit the assignment to be made; or

(2) OEID to an entity eligible to receive one under §162.514(a), provided that the Secretary has sufficient information to permit the assignment to be made.

(b) Collect and maintain information about each health plan that applies for or has been assigned an HPID and each entity that applies for or has been assigned an OEID, and perform tasks necessary to update that information.

(c) If appropriate, deactivate an HPID or OEID upon receipt of sufficient information concerning circumstances justifying deactivation.

(d) If appropriate, reactivate a deactivated HPID or OEID upon receipt of sufficient information justifying reactivation.

(e) Not assign a deactivated HPID to any other health plan or OEID to any other entity.

(f) Disseminate Enumeration System information upon approved requests.

§162.510   Full implementation requirements: Covered entities.

(a) A covered entity must use an HPID to identify a health plan that has an HPID when a covered entity identifies a health plan in a transaction for which the Secretary has adopted a standard under this part.

(b) If a covered entity uses one or more business associates to conduct standard transactions on its behalf, it must require its business associate(s) to use an HPID to identify a health plan that has an HPID when the business associate(s) identifies a health plan in a transaction for which the Secretary has adopted a standard under this part.

§162.512   Implementation specifications: Health plans.

(a) A controlling health plan must do all of the following:

(1) Obtain an HPID from the Enumeration System for itself.

(2) Disclose its HPID, when requested, to any entity that needs the HPID to identify the health plan in a standard transaction.

(3) Communicate to the Enumeration System any changes in its required data elements in the Enumeration System within 30 days of the change.

(b) A controlling health plan may do the following:

(1) Obtain an HPID from the Enumeration System for a subhealth plan of the controlling health plan.

(2) Direct a subhealth plan of the controlling health plan to obtain an HPID from the Enumeration System.

(c) A subhealth plan may obtain an HPID from the Enumeration System.

(d) A subhealth plan that is assigned an HPID from the Enumeration System must comply with the requirements that apply to a controlling health plan in paragraphs (a)(2) and (a)(3) of this section.

§162.514   Other entity identifier.

(a) An entity may obtain an Other Entity Identifier (OEID) to identify itself if the entity meets all of the following:

(1) Needs to be identified in a transaction for which the Secretary has adopted a standard under this part.

(2) Is not eligible to obtain an HPID.

(3) Is not eligible to obtain an NPI.

(4) Is not an individual.

(b) An OEID must be obtained from the Enumeration System identified in §162.508.

(c) Uses for the OEID. (1) An other entity may use the OEID it obtained from the Enumeration System to identify itself or have itself identified on all covered transactions in which it needs to be identified.

(2) The OEID may be used for any other lawful purpose.



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