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Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

June 1, 2017

Testimony focused on concerns facing the Unique Health Plan Identifier (HPID)

RESTON, Va. — June 1, 2017 — 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 and a trusted advisor to the U.S. Department of Health and Human Services (HHS), presented testimony on May 4, 2017 before the Department of Health and Human Services, National Committee on Vital and Health Statistics (NCVHS), Subcommittee on Standards. Laurie Darst, Chair of the WEDI Board of Directors, presented testimony concerning the future of the Unique Health Plan Identifier (HPID) under the Administrative Simplification provisions of the Affordable Care Act (ACA).

According to WEDI’s May 4 testimony: “In July 2015, the Centers for Medicare & Medicaid Services (CMS) issued a ‘Request for Information (RFI) on the Requirements for the HPID.’ At that time, WEDI held a Technical Advisory Committee (TAC) to provide a forum for healthcare organizations to convene, discussing in detail issues relating to regulatory provisions for the HPID. The outcome of the discussion was a set of comments that were reviewed and approved by the 2015 WEDI Board of Directors’ Executive Committee. WEDI found after holding many discussions with its members upon publication of the Final Rule in 2012 that perceptions of what HPID would provide the industry versus the realities of how health plans intended to enumerate had changed. We have not heard any new feedback from WEDI members which would modify our comments to HHS/CMS in response to the RFI in July 2015.”

WEDI’s testimony also addressed several questions put forth from the Subcommittee including those pertaining to the benefits and challenges seen with the current HPID model established by HHS.

“WEDI members have not identified any benefits to the HPID model as established by the final regulation. Implementation of the provisions within the HPID regulation would create challenges and barriers to the workflows and transaction streams currently in use,” said Darst. “Our recommendations remain the same today as they did back in July 2015, that being HPID not be used in transactions and that HPID is not needed at all. WEDI supports the continued efforts of all stakeholders towards achieving administrative simplification within healthcare and supports focusing collaboration and communication among industry participants on topics that bring value to the industry.”

WEDI has previously provided testimony on Operating Rules in 2010, 2011, 2015 and 2016 and will continue to monitor and update HHS on any pertinent industry regulatory changes in the future. WEDI’s complete May 4 testimony can be found here.

About WEDI
The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services (HHS) and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit and connect with us on TwitterFacebook and LinkedIn.

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