Eligibility and Claim Status Operating Rules Update

January 1, 2013 is rapidly approaching. This is the date by which HIPAA covered entities must implement the Department of Health and Human Services (HHS) Eligibility and Claim Status Operating Rules mandated under the Affordable Care Act. The Eligibility and Claim Status Operating Rules that HHS adopted by regulation in 2011 comprise the majority of those required for CAQH CORE’s voluntary Phase I and II certification. Emdeon became CORE Phase II certified in 2010, so Emdeon was in a strong position of readiness when HHS adopted these operating rules.

Emdeon has completed a thorough gap analysis in order to be ready by the compliance date. We are now concluding our remediation of any identified gaps.

Trading Partner Support
Emdeon is dedicated to help our clients complete this important transition successfully. We have already initiated testing with health plans that are ready to test their operating rule conformance.

In addition, we are actively engaging health plans who utilize our Eligibility and Claim Status Hosted Data Services (HDS). These health plans must:
• Migrate to version 3 of HDS if they are not on that version already; migration efforts for clients on prior versions are actively underway.
• Provide the proper data content in their eligibility files. (There are no data content requirements for the Claim Status transaction)

HIPAA Simplified
Our HIPAA Simplified website, www.hipaasimplified.com, remains the primary resource for information regarding the operating rules and other HIPAA and ACA regulations.

On the Operating Rules pages, you will find the newly updated Operating Rules Playbook. This publication is full of valuable information, including our operating rule program management structure, roles and responsibilities, educational material on the rules themselves and a new section specific to the upcoming ERA/EFT Operating Rules.

HIPAA Simplified is updated regularly, so check back often!






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