Reading Your HPI ID Card, and Who Health Plans, Inc. Is

If your health plan card says Health Plans, Inc. or HPI, your employer probably self-funds its health benefits and hired HPI to run them. That arrangement explains almost everything on the card, including why the claims address and payer ID can differ from one HPI plan to the next. Here is what HPI is, and how to read the card. The main mailing address is on our Health Plans Inc claims address page.

Who Health Plans, Inc. is

A TPA is not an insurance company in the usual sense. In a self-funded plan the employer pays the medical bills from its own funds, and HPI handles the administration: enrollment, ID cards, claims processing, customer service and appeals. HPI's clients include employers, municipalities and union-sponsored (Taft-Hartley) plans. Because each client designs its own plan, two people with HPI cards can have very different benefits, networks and phone numbers.

Front of the card: who you are and which network you use

• Member ID. HPI's provider instructions describe it as a 9-digit patient ID beginning with HH. Providers use it to check eligibility and claim status, and Harvard Pilgrim's payer chart uses the HH prefix to route electronic claims to payer ID 04271.
• Your employer's plan or group name. This is the plan sponsor, the organization actually paying the claims.
• Network logos. HPI explains that another payer's logo on the card means that network partners with HPI for your plan. HPI names UnitedHealthcare, Cigna, Employers Health Network and Prime Health Services as examples, and Harvard Pilgrim appears on many cards. The logo tells a provider which network contract, and which filing rules, apply.
• Copays. HPI notes that copay amounts are listed on the card.

Back of the card: where claims and calls go

• Claims address and electronic payer ID. HPI tells providers to review these on the back of each patient's card, because they can vary by plan and network. When present, they override the general address.
• Provider Services and Member Services numbers. These are usually plan-specific lines, often faster than the general HPI number.
• Precertification number. HPI's member FAQ explains that before an elective hospital admission or certain surgical or outpatient procedures, you or your doctor must call the precertification number listed on the card.

Using the card at the front desk

HPI acknowledges that every practice management system is different, so HPI plans may not show up the same way in each one. It suggests searching for names that match the card, such as "HPI" or "Health Plans Inc", and notes that some systems allow a search by PO Box or ZIP code. Front-desk staff should scan both sides of the card at every visit, since employers change networks and vendors at plan renewal.

Common mix-ups on HPI cards

• Treating the network as the payer. A Cigna or UnitedHealthcare logo on an HPI card identifies the provider network, not where the claim goes. Unless the back of the card says otherwise, the claim still goes to HPI.
• Using an old card. Employers can change networks, vendors or administrators at renewal. A card from last year may carry an outdated address or payer ID.
• Mixing up Harvard Pilgrim and HPI. They are related companies with different claims addresses. An HH member ID points to an HPI-administered plan.
• Calling the wrong number. The general HPI line can help, but the plan-specific number on the card usually reaches staff who know your employer's plan.

Where to get a new card or check claims

Members can view claims and download an ID card through HPI's member portal (often called My Plan) or the website for their specific plan. Providers can request access to HPI's provider portal using their NPI or tax ID, then search eligibility and claims by the HH patient ID. If you are unsure which HPI website serves your plan, call the number on the card or the general customer service line, 800-532-7575.

HPI's official corporate headquarters. Claims, appeals and member forms go to PO Box 5199, not this building. For appeal steps see the HPI appeals guide; for electronic billing see the HPI payer ID guide.