WEDI CAQH Audiocast:
Is Your Organization Prepared to Adopt Mandated Healthcare Operating Rules?
Thursday, May 24, 2012 (2pm - 3:30pm US/Eastern)
The first operating rule set, issued by CMS in December 2011, mandates the adoption of CAQH CORE Operating Rules for Eligibility and Claim Status. This mandate applies to all HIPAA covered entities and is effective January 1, 2013.
Subsequently, on January 1, 2014, operating rule regulations will become effective for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). CAQH CORE was recommended by the National Committee on Vital and Health Statistics (NCVHS) to be the authoring entity to meet ACA requirements for the second set of mandated operating rules for EFT and ERA transactions. The draft CAQH CORE EFT & ERA Operating Rules have been recommended by NCVHS to the Secretary of Health and Human Services (HHS) for adoption. The remaining operating rule regulations will take effect on January 1, 2016.
Prepare attendees to assist their organization in meeting the first federally mandated operating rule requirements for Eligibility for a Health Plan and Health Care Claims Status transactions. This session will address the important role that both data content and infrastructure operating rules play in facilitating interoperability between health plans and providers.
Attendees will be able to:
<LI>Describe the timeline for adoption of federally mandated operating rules and identify how CAQH CORE Operating Rules apply to HIPAA covered entities that engage in the exchange of administrative data
<LI>Review each of the CAQH CORE mandated operating rules for Eligibility for a Health Plan and Healthcare Claim Status, including CAQH CORE Operating Rules drafted for Electronic Funds Transfer and Remittance Advice transactions
<LI>Identify key steps necessary to successfully implement Eligibility for a Health Plan and Health Care Claims Status Operating Rules within their organization
<LI>Describe how operating rules build upon existing standards, e.g. eligibility and patient financials; a special emphasis will be placed on the role of connectivity and security in providing a safe harbor for application vendors, providers and health plans to implement and streamline data exchange between parties
Erik J. Newlin, Director of National Standards Consulting, Xerox State Healthcare, LLC
Bob Bowman, CORE Manager
Harvard Pilgrim Health Care, Inc.
David Querusio, Director eBusiness Architecture
Rhonda Starkey, Manager of Provider eBusiness Operations
About Harvard Pilgrim
Harvard Pilgrim is a not-for-profit health plan that provides a variety of insurance plan options and self-funding arrangements to more than one million members in Massachusetts, New Hampshire and Maine.
Harvard Pilgrim was an early adopter of the CAQH CORE Operating Rules and is a Phase I and Phase II CORE-certified health plan. They were named the #1 private health plan in America according to an annual ranking of the nation’s best health plans by the National Committee for Quality Assurance (NCQA).
Xerox serves programs across the entire healthcare ecosystem – from providers and payers to employers and government agencies. Xerox State Healthcare, LLC is a Xerox Company.
Xerox’s EDI Direct-Eligibility Engine clearinghouse service (formerly known as ACS, EDI Gateway’s EDI Direct-Eligibility Engine) is a Phase I and Phase II CORE-certified clearinghouse.
About CAQH CORE
CORE, an initiative of CAQH, is a national multi-stakeholder initiative with over 130 participating organizations that is working to streamline electronic healthcare administrative data exchange and improve health plan-provider interoperability through the development of industry-wide operating rules.
CAQH CORE has been designated by Health and Human Services (HHS) as the authoring entity for Eligibility for a Health Plan and Healthcare Claim Status transactions. CAQH CORE was also recommended by National Committee on Vital and Health Statistics (NCVHS) as the authoring entity for the second set of mandated operating rules for Electronic Funds Transfer and Electronic Remittance Advice transactions. To learn more about CAQH CORE, visit
All paid registrants will receive dial-in instructions on
Monday, May 23
. The registration fee allows you to dial in one time to the event. You may conference in as many people as you would like into your phone line, but you may not dial into the official audiocast line more than once. Those who dial into the call with more than one phone line will be billed additional registration fees.
Please note: your payment must be complete in order to gain access to the event.
Who Should Attend:
<LI>Healthcare industry stakeholders who use, transmit or create healthcare administrative data
<LI>Industry professionals involved in efforts to streamline healthcare administration
<LI>Health Plans, Vendors, Clearinghouses, Providers, Associations, Regional Entities, and State and Federal Government Agencies</UL>
Cancellation and Other Policies:
WEDI does not accept cancellations, but substitute attendees are permitted.
Is Media Allowed?
For more information please contact:
Director, Programs & Services