ICD-10 Date, Plan Identifier & New EDI Provisions Finalized in CMS Rule


The Centers for Medicare and Medicaid Services has officially set Oct. 1, 2014 as the new ICD-10 compliance date in a final rule that also adopts several new financial/administrative provisions.

In the rule available here with publication in the Federal Register on Sept. 5, CMS establishes a unique health plan identifier, which originally was mandated under the 1996 HIPAA law but never pushed through by previous administrations.

The final rule also mandates adoption of a data element to serve as an “other entity” identifier for entities that are not health plans, providers or individuals, but need to be identified in standard electronic transactions, such as an ambulance service.

Further, the rule requires “organization covered” providers who are prescribers to obtain a National Provider Identifier. These are practitioners who are not covered entities under HIPAA because they do not conduct standard transactions, but pharmacies have had trouble getting claims processed because of the lack of an NPI.
CMS anticipates the new provisions will save $6 billion over 10 years.

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