{"abstract":"This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID. In addition, it adopts a data element that will serve as an other entity identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions. This final rule also specifies the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). Lastly, this final rule changes the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD- 10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2012/09/05/2012-21238.html","cfr_references":[{"chapter":null,"citation_url":null,"part":162,"title":45}],"citation":"77 FR 54664","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective date: These regulations are effective on November 5, 2012. Compliance dates: Health plans with the exception of small health plans must obtain an HPID by November 5, 2014. Small health plans must obtain an HPID by November 5, 2015. Covered entities must use HPIDs in the standard transactions on or after November 7, 2016. An organization covered health care provider must comply with the implementation specifications in Sec. 162.410(b) by May 6, 2013.","disposition_notes":null,"docket_ids":["CMS-0040-F"],"dockets":[],"document_number":"2012-21238","effective_on":"2012-11-05","end_page":54720,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2012/09/05/2012-21238.xml","html_url":"https://www.federalregister.gov/documents/2012/09/05/2012-21238/administrative-simplification-adoption-of-a-standard-for-a-unique-health-plan-identifier-addition-to","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2012-21238?publication_date=2012-09-05","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2012-09-05/2012-21238/mods.xml","not_received_for_publication":null,"page_length":57,"page_views":{"count":9377,"last_updated":"2026-10-25 10:15:05 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2012-09-05/pdf/2012-21238.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2012-21238.pdf?1345824128","publication_date":"2012-09-05","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2012/09/05/2012-21238.txt","regulation_id_number_info":{"0938-AQ13":{"issue":"201110","html_url":"https://www.federalregister.gov/regulations/0938-AQ13/administrative-simplification-standard-unique-identifier-for-health-plans-cms-0040-p-","title":"Administrative Simplification: Standard Unique Identifier for Health Plans (CMS-0040-P)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201110&RIN=0938-AQ13&operation=OPERATION_EXPORT_XML","priority_category":"Other Significant"}},"regulation_id_numbers":["0938-AQ13"],"regulations_dot_gov_info":{"supporting_documents":[],"regulatory_plan":{"html_url":"https://www.federalregister.gov/regulations/0938-AQ13/administrative-simplification-standard-unique-identifier-for-health-plans-cms-0040-p-","title":"Administrative Simplification: Standard Unique Identifier for Health Plans (CMS-0040-P)"},"comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2012-0043","supporting_documents_count":0,"docket_id":"CMS-2012-0043","regulation_id_number":"0938-AQ13","title":"Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier, Addition to the National Provider Identifier Requirements and ICD-10 Compliance Date Delay","checked_regulationsdotgov_at":"2012-09-25T08:03:32Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":54664,"subtype":null,"title":"Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets","toc_doc":"Adoption of Standard for Unique Health Plan Identifier; Addition to National Provider Identifier Requirements, etc.","toc_subject":"Administrative Simplification:","topics":["Administrative practice and procedure","Health facilities","Health insurance","Hospitals","Incorporation by reference","Medicaid","Medicare","Reporting and recordkeeping requirements"],"type":"Rule","volume":77}