MGMA Wants CORE to Lead HIPAA Transactions Standardization

The Medicare Group Management Association is asking federal officials to name the Committee on Operating Rules for Information Exchange (CORE) initiative of CAQH, an alliance of industry stakeholders, as the authoring entity for operating rules that make the HIPAA transactions more uniform.

The Affordable Care Act mandates adoption of a series of operating rules between 2013 and 2016. CORE has spent several years working on rules specified in the reform law, and which currently are being voluntarily adopted. The National Council for Prescription Drug Programs, in consultation with CORE, has been developing separate operating rules for pharmacy transactions.

"Designating more than one entity to develop an operating rule, unless the entities are specifically chartered to work collaboratively, will result in these organizations competing for scarce resources and diminishing the potential for industry collaboration and consensus," MGMA notes in comments on the interim final rule to adopt operating rules for electronic insurance eligibility and claims status transactions.

The association also recommends the designated entity "receive appropriate financial support" from the Department of Health and Human Services. Other recommendations in the comment letter to the Centers for Medicare and Medicaid Services include:

* Adoption of a companion guide template and companion guide principles from the Workgroup for Electronic Data Interchange and the ANSI ASC X12 committee in addition to the CORE companion guide template, with the organizations collaborating on further templates;

* Establishment of a process so the industry can submit requests for interpretations of operating rules, with the interpretations made public;

* Require the operating rule entity to seek input from standards development organizations through participation on all boards and work groups, and to include SDOs in the review process;

* Include operating rules for acknowledgement transactions, which are not part of the reform law specified transactions and which the American Hospital Association also has asked be included;

* Give precedence to an existing standard when an operating rule requirement conflicts with that of the underlying standard;

* Clarify that no provision within operating rules should require CORE certification of a covered entity; and

* Formally include practice management system vendors in the operating rules development process.

The MGMA comment letter on CORE operating rules is available here.