Healthcare Administrative Transactions Simplified: The Role of Mandated Operating Rules
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.