Healthcare Administrative Transactions Simplified: The Role of Mandated Operating Rules

June 25, 2012
3:00PM-4:30PM ET

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.

Ross Lippincott, Vice President Provider and Network Services Operations for United Health Group, will provide a first- hand account of United Healthcare’s implementation experience. Special emphasis will be placed on the importance of achieving industry-wide interoperability between health plans and providers including the integration role that operating rules play in the adoption of healthcare standards across the healthcare enterprise.

Download today's presentation slides here.

NeHC would like to thank CAQH CORE for generously sponsoring this NeHC University program.

LEARNING OBJECTIVES

Attendees will be able to:

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

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