The compliance dates for use of the operating rules are:
January 1, 2013 for:
- eligibility for a health plan
- health claim status
January 1, 2014 for:
- electronic funds transfers (EFT)
- health care payment and remittance advice (ERA)
January 1, 2016 for:
The purpose of operating rules is to add additional administrative simplification to the electronic standard transactions by requiring specific business actions so that the standards can be performed in a more uniform way.
Eligibility and Claim Status
On June 30, 2011, HHS adopted through an Interim Final Rule with Comments (IFC) operating rules for eligibility for a health plan and health care claim status transactions. The IFC was finalized by HHS on December 7, 2011.
Covered entities, as defined by HIPAA, must comply with the named operating rules by January 1, 2013.
EFT and ERA
The IFC for EFT and ERA operating rules was published on August 10, 2012. The expected compliance date for these operating rules is January 1, 2014.
Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) - CORE is the authoring entity for the named operating rules.