This morning, the CAQH Committee on Operating Rules for Information Exchange (CORE) today announced the approval of the Phase IV CAQH CORE Operating Rules package for four healthcare business transactions: healthcare claims; prior authorization; employee premium payment; and enrollment and disenrollment in a health plan.
In an effort to ensure that large amounts of data can be shared electronically across the healthcare system, the Affordable Care Act (ACA) mandated national operating rules for the existing HIPAA administrative standards.
According to a provided statement, the Department of Health and Human Services (HHS) selected CAQH CORE as the “authoring entity to develop those operating rules, which specify the actions needed to ensure uniform, reliable electronic data transmission.”
We’re told that the rules apply to all HIPAA-covered entities, including health plans, clearinghouses and healthcare providers. Phase IV represents the next step in developing operating rules for all HIPAA transactions.
“These operating rules are an important step in moving the healthcare system from manual to electronic business transactions,” said CAQH CORE Board Chair George S. Conklin, Senior Vice President and Chief Information Officer for CHRISTUS Health. “When each entity in the process follows the operating rules, everyone benefits from reductions in costs, time and confusion.”