InformationWeek, January 8, 2014

The Department of Health and Human Services (HHS) has proposed that all health plans get certified for compliance with the HIPAA standards and operating rules required for three types of administrative transactions, including insurance eligibility, claims status, and electronic funds transfer/electronic remittance advice (EFT/ERA). This certification would help the government enforce existing requirements that plans use these operating rules. The CORE committee of the Coalition for Affordable Quality Healthcare (CAQH) developed the operating rules, which have been endorsed by HHS. CAQH CORE seeks to build consensus among industry stakeholders, including health plans, on operating rules that facilitate administrative interoperability between healthcare providers and health plans.
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