alejandro rodolfo dans
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A feature story in the November issue of Health Data Management examines the rollout of HIPAA “operating rules” to better standardize electronic claims and related transactions, while giving providers more information from insurers. Only insurers are mandated to support the rules, although it’s obviously good business for software vendors to also comply. Operating rules for eligibility verification and claim status now are in force, with a January 2014 compliance date for electronic funds transfer and electronic remittance advice rules. A group of rules come in 2016: claims/encounters, coordination of benefits, plan enrollment/disenrollment, plan premium payment, referral certification/authorization, and claims attachments if that transaction is ready.

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