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WEDI’s HPID Workgroup Announces Release of Issue Brief: “What is the Difference Between a Health Plan and Payer?”
Date:7/28/2014

Reston, VA (PRWEB) July 28, 2014

The Workgroup for Electronic Data Interchange (WEDI), the nation’s leading nonprofit authority on the use of health IT to create efficiencies in healthcare information exchange, announced today its Health Plan Identifier (HPID) Workgroup has developed an issue brief titled, “What is the Difference Between a Health Plan and Payer?” The HPID Workgroup, a part of WEDI’s Strategic National HPID Implementation Process, worked closely with the Centers for Medicare and Medicaid Services (CMS) to identify common misuse of the terms “health plan” and “payer” across the industry.

These terms, often used interchangeably in the regulation, can cause a misconception of an organization’s role. In an effort to help the industry understand the differences in these terms and how to best use them, WEDI partnered with ASC X12 to develop this issue brief, which includes definitions of both terms and clarifies the role each plays in standard transactions according to the HPID Final Rule.

The brief further explains these defined terms as they are affected by the HPID Final Rule compliance date. An organization currently identified as a payer will continue to be identified as such. However, one that is currently identified as a health plan – and continues to be identified as a health plan after November 7, 2016 – must use an HPID.

“The lack of clarity around the definition of a health plan and payer has caused significant challenges among the payer community in the development of their enumeration stra
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