A proposed rule from the Department of Health and Human Services would require health insurers to certify compliance by the end of 2015 with HIPAA operating rules governing more uniformity of insurance eligibility, claim status, electronic funds transfer and remittance advice transactions.

“This proposed rule is intended to serve as an initial step toward the development of a consistent testing process or framework before implementation of new standards and operating rules,” according to the rule published on Jan. 2. Documentation of compliance would include an indication that a health plan has completed some internal and external testing. To the degree they support various HIPAA transactions, the business associates and subcontractors of insurers also must comply with pertinent operating rules.

Health insurers are presently expected to be supporting the initial operating rules that became effective in January 2013 (eligibility & status) and January 2014 (EFT/ERA). The new certification process will formalize proof of compliance. In time, the certification program also will cover a range of additional operating rules that become effective in 2016. They include claims/encounters, coordination of benefits, health plan enrollment/disenrollment, plan premium payment, referral certification and authorization, and claims attachments if that transaction is ready.

A story in the November 2013 issue of Health Data Management walks through the HIPAA operating rules now in effect and coming in later years, as well as early experiences from providers, payers and vendors. A printable copy of the story is available here.

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