Administrative Simplification Operating Rules Update

September 5, 2013

The Affordable Care Act (ACA) mandates implementation of new Administrative Simplification operating rules to promote greater uniformity in the exchange of electronic health care data. The Committee on Operating Rules for Information Exchange (CORE) is part of the Council for Affordable Quality Healthcare (CAQH) initiative. CAQH CORE has authored operating rules to be implemented in phases for HIPAA-standard electronic data interchange (EDI) transactions. 

Blue Cross and Blue Shield of Illinois (BCBSIL) is currently making system enhancements as required by CAQH CORE to meet the deadline of Jan. 1, 2014, for implementation of operating rules for 835 Electronic Funds Transfer (EFT) and 835 Electronic Remittance Advice (ERA) transactions. Our August Blue Review  included an article titled, ‘Moving into the Next Phase of Administrative Simplification.’ This article offers an overview of what’s changing and potential benefits to your practice. 

We also want to alert you that, as of Jan. 1, 2014, providers may likely see changes related to patient share and liability. As a result, we encourage you to visit the CORE Phase III Rules page  of the CAQH website to view scenarios and determine potential impact related to implementation of the operating rules for electronic claim payment and remittance transactions. 

CAQH CORE is a multi-stakeholder collaboration of more than 130 organizations representing providers, health plans, vendors, government agencies, and standard-setting bodies developing operating rules to help simplify health care administrative transactions. For additional information, refer to the CORE section  of the CAQH website.