The Centers for Medicare and Medicaid Services has issued guidance on implementation of “operating rules” that tighten uniformity of the HIPAA eligibility and claim status transactions.

The guidance targets the Medicaid and CHIP programs. The Affordable Care Act mandates adoption of a series of operating rules between 2013 and 2016, starting with eligibility and status. “We are highlighting the individual operating rules here so that States are aware of the requirements,” according to the guidance. “It will be important for States to secure a copy of the operating rules which are available at no charge from the Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange Web site at caqh.org. Further, CAQH CORE staff are available for technical questions and guidance, and CORE conducts frequent town hall meetings and webinars that are free of charge.”

The guidance walks through provisions of the operating rules and also touches on elements of the rules that the Department of Health and Human Services did not adopt. These include mandated CORE certification, and use of acknowledgement standards, both of which at this time are voluntary.
The guidance is available here.

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