SDOs & Operating Rules Updates

CMS Issues Update on Holding of Claims for Affected Services. The Centers for Medicare & Medicaid Services (CMS) provided an update on the processing of claims and payments for services affected by the expired Medicare legislative provisions as of October 1. CMS has instructed Medicare Administrative Contractors to hold these claims but will continue to…

CMS Contracts Signal Commitment to Development of National Provider Directory. On September 30, the Centers for Medicare & Medicaid Services (CMS) awarded four contracts of $1 each to Availity, LLC, Council for Affordable Quality Healthcare, Inc, Gainwell Technologies, LLC, and Palantir Technologies, Inc. The stated purpose of the contracts is to procure information technology services…

OSTP and FDA Request Public Input on AI Use. The White House’s Office of Science and Technology Policy (OSTP) published a Request for Information (RFI) titled “Regulatory Reform on Artificial Intelligence” seeking input on identifying federal legislation, regulations, guidance, or other requirements that impede the development, deployment, and adoption of artificial intelligence (AI) technologies. The…

OCR Settles HIPAA Investigation of PHI Disclosure by Delaware Provider. The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) announced a settlement with a Delaware health care provider for a potential violation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Breach Notification Rules. The settlement resolves an investigation…

Hear from WEDI Chair-Elect, Denny Brennan, on why interoperability matters in the health care industry.

WEDI is conducting this follow up survey on the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F), and we need your help! This short survey will gauge how the industry is implementing this regulation. Don’t miss this important opportunity to share your perspectives on this significant industry mandate. WEDI’s second survey on…

WEDI Sends NSA Letter to Ways and Means Outlining Challenges with AEOBs. WEDI sent to the House Committee on Ways and Means its letter on the No Surprises Act (NSA) that it sent on September 8 to the Secretaries of the Departments of Health and Human Services (HHS), Labor, and Treasury and Director of the…

WEDI Urges Action on No Surprises Act GFE and AEOB Provisions. WEDI sent a letter to the Departments of Health and Human Services (HHS), Labor, Treasury, and the Office of Personnel Management (OPM) outlining critical data exchange issues related to the Good Faith Estimation (GFE) and Advanced Explanation of Benefits (AEOB). Both the GFE and…

X12 Publishes 008060 Versions of HIPAA-Mandated Implementation Guides. Standards Development Organization X12 has published the first of the 008060 versions of the HIPAA-mandated implementation guides. The rest of those 008060 versions will be published over the next few weeks. These updated implementation guides can be viewed in X12’s online viewer, Glass, at  products.x12.org and navigate to…