The Affordable Care Act mandated adoption of operating rules, which have been under development and voluntarily adopted for several years. The reform law called on the National Committee on Vital and Health Statistics, an HHS advisory body, to recommend an authoring entity. NCVHS previously recommended CORE as the authoring entity for eligibility, status and EFT/ERA transactions, which HHS accepted. The eligibility and claim status operating rules have a compliance date of January 1, 2013, with EFT/ERA mandated for use a year later.
NCVHS later again recommended CORE to author the remaining operating rules. Now, the new authority from Sebelius means CORE will develop operating rules-with a January 1, 2016, compliance date-for claims/encounters, coordination of benefits, enrollment/disenrollment, premium payments, attachments, and referral certification/authorization. Some of this work has been proceeding in anticipation of CORE being the authoring entity, as no other viable candidate presently exists.
In recommending CORE to complete the operating rules, NCVHS also recommended that CORE explicitly collaborate with the Workgroup for Electronic Data Interchange. While acknowledging the request was intended to ensure a base level of industry participation, HHS declined to accept the recommendation. "However, HHS expects that CORE will collaborate with all relevant industry stakeholders; HHS typically does not designate specific organizations in this way," Sebelius explained in a letter accepting NCVHS' recommendation of CORE. "HHS urges independent participation by all other industry stakeholders."
Health Level Seven has been leading the work to develop standards for claims attachments, with the Digital Imaging and Communications in Medicine coalition doing the work for medical imaging attachments. But the attachments work for HL7 has gone slowly. Asked if there is concern that the 2016 compliance date could slip for attachments, CORE Managing Director Gwendolyn Lohse says, "There's no doubt there's a lot of work to do, but it's doable."