Ten Months Away from First Deadline for Implementing Federally-Mandated Operating Rules for Administrative Simplification
This session will build on the August 2011 Webinar presented by CAQH to SPBA members, entitled "CAQH CORE Operating Rules and Health Reform: Streamlining Administrative Transactions". The presentation will provide an update on the progress of CAQH CORE in relation to the ACA operating rules and explain the potential impact on SPBA members' work.
Since 2005, CAQH CORE has worked to streamline healthcare administration by developing operating rules through a collaboration of more than 130 stakeholders – health plans, providers, vendors, clearinghouses, government agencies, and associations. The CAQH CORE operating rules build on standards to give providers access to patient coverage and financial information before or at the time of service using the electronic system of their choice for any patient or health plan. More than 50 organizations, including health plans representing over 120 million lives, have voluntarily adopted and implemented the CAQH CORE operating rules through a CORE-certification process.
The Administrative Simplification section of the ACA requires health plans to adopt operating rules. According to the ACA, three sets of healthcare industry operating rules will be approved by the Department of Health and Human Services (HHS) and then implemented by the industry based on a series of deadlines occurring over the next five years. The three sets of nationally mandated operating rules include: (1) Eligibility and Claim Status; (2) Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA); and (3) Enrollment, Referral authorization, Attachments, etc. The operating rules are intended to streamline administrative exchanges and promote interoperability across the healthcare industry.
In December, 2011, HHS adopted the CAQH CORE Operating Rules for the first set of ACA requirements. All HIPAA covered entities will be required to comply with these Federally-mandated operating rules by January 1, 2013. The National Committee on Vital and Health Statistics (NCVHS), an advisor to HHS has recommended CAQH CORE, in collaboration with NACHA – The Electronic Payments Association, as the authoring entity for operating rules for healthcare EFT and ERA transactions, and issued a letter recommending HHS adopt the five Draft CAQH CORE EFT and ERA Operating Rules.
Who Should Attend
Since 2005, CAQH CORE has worked to streamline healthcare administration by developing operating rules through a collaboration of more than 130 stakeholders – health plans, providers, vendors, clearinghouses, government agencies, and associations. The CAQH CORE operating rules build on standards to give providers access to patient coverage and financial information before or at the time of service using the electronic system of their choice for any patient or health plan. More than 50 organizations, including health plans representing over 120 million lives, have voluntarily adopted and implemented the CAQH CORE operating rules through a CORE-certification process.
The Administrative Simplification section of the ACA requires health plans to adopt operating rules. According to the ACA, three sets of healthcare industry operating rules will be approved by the Department of Health and Human Services (HHS) and then implemented by the industry based on a series of deadlines occurring over the next five years. The three sets of nationally mandated operating rules include: (1) Eligibility and Claim Status; (2) Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA); and (3) Enrollment, Referral authorization, Attachments, etc. The operating rules are intended to streamline administrative exchanges and promote interoperability across the healthcare industry.
In December, 2011, HHS adopted the CAQH CORE Operating Rules for the first set of ACA requirements. All HIPAA covered entities will be required to comply with these Federally-mandated operating rules by January 1, 2013. The National Committee on Vital and Health Statistics (NCVHS), an advisor to HHS has recommended CAQH CORE, in collaboration with NACHA – The Electronic Payments Association, as the authoring entity for operating rules for healthcare EFT and ERA transactions, and issued a letter recommending HHS adopt the five Draft CAQH CORE EFT and ERA Operating Rules.
Who Should Attend
Direct employees of SPBA member TPA firms and Stop-Loss Partners should attend.
Once you have registered you will need to tell your technical people to set your firewalls to accept email from two different email addresses: support@peachnewmedia.com and jgalusha@peachnewmedia.com. Confirmation emails and reminders will be sent from these two different emails.
Technical Warning – Microsoft Live Meeting is the software used to run the webinar. Many Windows-based computers have recently upgraded their Internet Explorer browsers and have reported some difficulties in running Live Meeting. Please be certain to check your systems early for Microsoft Live Meeting compatibility to avoid problems on the day of the webinar.
Once you have registered you will need to tell your technical people to set your firewalls to accept email from two different email addresses: support@peachnewmedia.com and jgalusha@peachnewmedia.com. Confirmation emails and reminders will be sent from these two different emails.
Technical Warning – Microsoft Live Meeting is the software used to run the webinar. Many Windows-based computers have recently upgraded their Internet Explorer browsers and have reported some difficulties in running Live Meeting. Please be certain to check your systems early for Microsoft Live Meeting compatibility to avoid problems on the day of the webinar.
- Summarize the status of operating rules required by the Patient Protection and Affordable Care Act (ACA).
- Review the Federally-mandated CAQH CORE Operating Rules and preparations underway to meet ACA adoption deadlines.
- Explore the potential impact of operating rules for various healthcare stakeholders, including TPA firms, given the recent mandate.
Date Presented:
March 27, 2012 1:00 PM Eastern
Length:
1 hour, 30 minutes
Streaming - Recording
SPBA Price:$175.00