Healthcare Administrative Transactions Simplified: The Role of Mandated Operating Rules
June 25, 2012
COURSE DESCRIPTION: On June 25, NeHC and CAQH CORE will present a joint program on the national healthcare operating rule mandate as detailed in Section 1104 of the Affordable Care Act (ACA). Section 1104 establishes a national healthcare operating rule mandate in support of the industry’s ongoing administrative simplification efforts. It applies to all HIPAA covered entities. CAQH CORE, the designated authoring entity for the first two-sets of mandated operating rules, will provide an overview of Eligibility for a Health Plan and Healthcare Claim Status Operating Rules that become effective January 1, 2013. Operating rules are those business rules and guidelines that make an electronic transaction more predictable and consistent, regardless of technology used. They are used by many industries to achieve interoperability – consider ATMs or cell phones. This program will highlight how organizations and their trading partners can reduce administrative costs, facilitate faster access to needed patient financials, claim status look-ups and simplify connectivity between trading partners.
- Recognize the essential role of operating rules on both administrative simplification and care delivery; understand how they are streamlining the exchange of administrative data while aligning with Nationwide Health Information Network (NwHIN) initiatives
- Understand the timeline for adoption of federally mandated operating rules and identify the beneficial impacts to HIPAA covered entities engaged in the electronic exchange of eligibility and claims status transactions
- Describe the key requirements of the first set of mandated operating rules effective January 2013, i.e. Eligibility for a Health Plan and Healthcare Claim Status
- Be ready to act upon the key steps necessary to successfully implement the mandated CAQH CORE Eligibility and Claim Status Operating Rules within their organization