An organization developing "operating rules" to tighten the HIPAA transactions standards will continue its work as a federal district court ruling that the health care reform law is unconstitutional moves through the Court of Appeals and Supreme Court.

The Affordable Care Act mandates development and adoption of a series of operating rules through 2016, but the court ruling puts the mandate in legal limbo. Still, the Committee on Operating Rules for Information Exchange within CAQH, an alliance of payers and trade associations, is proceeding as if the reform law will continue to move forward, says Gwendolyn Lohse, managing director. "The deadlines are pretty aggressive and if we can't keep doing our work we can't meet them."

For instance, CORE is working to complete the first mandated operating rule, covering eligibility and claim status transactions, by July 2011, with a compliance date of January 2013. CORE is making changes to an existing voluntary eligibility/status rule to conform to requirements under the reform law. The industry stakeholder organization also is working with the Electronic Payments Association, a banking group, to develop operating rules for electronic remittance advice and electronic funds transfer transactions covering non-retail pharmacy transactions. The ERA/EFT rules have a July 2012 adoption date and a January 2014 compliance date if the reform law is upheld.

The reform law authorized the National Committee on Vital and Health Statistics to recommend entities to create operating rules. NCVHS recently recommended CORE for non-retail pharmacy transactions and the National Council for Prescription Drug Programs for pharmacy transactions.

More information on CORE is available at

--Joseph Goedert


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