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WEDI CAQH Webinar: Is Your Organization Prepared to Adopt Mandated Healthcare Operating Rules?

Erik J. Newlin, Xerox State Healthcare, LLC; Bob Bowman, CAQH CORE; David Querusio, Harvard Pilgrim Health Care; Rhonda Starkey, Harvard Pilgrim Health Care

Electronic (digital download/no shipping)

Affiliate Member, For-Profit Member, Government Member, Individual Member, Non-Profit Member - $145.00
NonMember, eMember - $175.00


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. This webinar will 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: •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 •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 •Identify key steps necessary to successfully implement Eligibility for a Health Plan and Health Care Claims Status Operating Rules within their organization •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

Product Details:

Product ID: MISC-4
Publication Year: 2012