United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2011_register executive 2011-07-08 article Part II Rules and Regulations D09002ee1c7ffa06e D09002ee1c7ffa164 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Office of the Secretary originator org United States Government Agency or Subagency Section 1104 of the Administrative Simplification provisions of the Patient Protection and Affordable Care Act (hereafter referred to as the Affordable Care Act) establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs. Specifically, in section 1104(b)(2) of the Affordable Care Act, Congress required the adoption of operating rules for the health care industry and directed the Secretary of Health and Human Services to "adopt a single set of operating rules for each transaction * * * with the goal of creating as much uniformity in the implementation of the electronic standards as possible." This interim final rule with comment period adopts operating rules for two Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions: eligibility for a health plan and health care claim status. This rule also defines the term "operating rules" and explains the role of operating rules in relation to the adopted transaction standards. In general, transaction standards adopted under HIPAA enable electronic data interchange through a common interchange structure, thus minimizing the industry's reliance on multiple formats. Operating rules, in turn, attempt to define the rights and responsibilities of all parties, security requirements, transmission formats, response times, liabilities, exception processing, error resolution and more, in order to facilitate successful interoperability between data systems of different entities. 76 FR 40458 https://www.govinfo.gov/app/details/FR-2011-07-08/2011-16834 2011-16834 fr08jy11-18 RIN 0938-AQ12 4120-01-P CMS-0032-IFC https://www.govinfo.gov/app/details/FR-2011-07-08/2011-16834 https://www.govinfo.gov/content/pkg/FR-2011-07-08/html/2011-16834.htm https://www.govinfo.gov/content/pkg/FR-2011-07-08/pdf/2011-16834.pdf Administrative Practice and Procedure Computer Technology Health Care Health Facilities Health Insurance Health Records Hospitals Medicaid Medicare Penalties Reporting and Recordkeeping Requirements Administrative Practice and Procedures Electronic Transactions Incorporation by Reference 39 p. 40458 40496 76 FR 40458 Title 45 Part 160 45 CFR Part 160 Title 45 Part 162 45 CFR Part 162 RIN 0938-AQ12 Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions; Federal Register Vol. 76, Issue RULE 2011-16834 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 2011-06-30 CMS-0032-IFC 4120-01-P 2011-16834 Interim final rule with comment period.

Section 1104 of the Administrative Simplification provisions of the Patient Protection and Affordable Care Act (hereafter referred to as the Affordable Care Act) establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs. Specifically, in section 1104(b)(2) of the Affordable Care Act, Congress required the adoption of operating rules for the health care industry and directed the Secretary of Health and Human Services to "adopt a single set of operating rules for each transaction * * * with the goal of creating as much uniformity in the implementation of the electronic standards as possible." This interim final rule with comment period adopts operating rules for two Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions: eligibility for a health plan and health care claim status. This rule also defines the term "operating rules" and explains the role of operating rules in relation to the adopted transaction standards. In general, transaction standards adopted under HIPAA enable electronic data interchange through a common interchange structure, thus minimizing the industry's reliance on multiple formats. Operating rules, in turn, attempt to define the rights and responsibilities of all parties, security requirements, transmission formats, response times, liabilities, exception processing, error resolution and more, in order to facilitate successful interoperability between data systems of different entities.

Effective Date: These regulations are effective on June 30, 2011. The incorporation by reference of the publications listed in this interim final rule is approved by the Director of the Office of the Federal Register June 30, 2011. Shannon Whetzel (410) 786-3267. Matthew Albright (410) 786-2546. Denise Buenning (410) 786-6711. Administrative Practice and Procedure Computer Technology Health Care Health Facilities Health Insurance Health Records Hospitals Medicaid Medicare Penalties Reporting and Recordkeeping Requirements Administrative Practice and Procedures Electronic Transactions Incorporation by Reference Administrative Simplification: Adoption of Operating Rules for Eligibility for Health Plan and Health Care Claim Status Transactions , info@CAQH.org OIRA_submission@omb.eop.gov http://caqh.org/Host/CORE/SB135_COreport.pdf http://edocket.access.gpo.gov/2008/pdf/E8-19296.pdf http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf http://factfinder.census.gov/servlet/IBQTable?_bm=y&-ds_name=EC0752A1&-geo_id=01000US&-dataitem=* http://factfinder.census.gov/servlet/IBQTable?_bm=y&-geo_id=&-fds_name=EC0700A1&-_skip=0&-ds_name=EC0762SSSZ1&-_lang=en http://ncpdp.org/about.aspx http://ncpdp.org/WP.aspx http://regulations.gov http://transact.emdeon.com/documents/milliman_study.pdf http://www.acpinternist.org/archives/2000/12/claimsdenied.htm http://www.ahipresearch.org/pdfs/PromptPayFinalDraft.pdf http://www.ama-assn.org/ama1/pub/upload/mm/368/admin-simp-wp.pdf http://www.ama-assn.org/ama1/pub/upload/mm/368/hipaa-tcs.pdf http://www.ambanet.net/AMBA.htm http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html http://www.caqh.org/about.php http://www.caqh.org/benefits.php http://www.caqh.org/COREIBMstudy.php http://www.caqh.org/COREVersion5010.php http://www.caqh.org/pdf/CLEAN5010/MasterCompGuidTemp-Version http://www.cbo.gov/ftpdocs/113xx/doc11379/AmendReconProp.pdf http://www.cdc.gov/nchs/data/databriefs/db41.htm http://www.cdc.gov/nchs/data/series/sr_13/sr13_169.pdf http://www.census.gov/services/sas_data.html http://www.cooperativeexchange.org/faq.html http://www.ec-edi.biz/content/en/dir-guest-login.asp http://www.ec-edi.biz/content/en/dir-guest-login.asphttp://www.ec-edi.biz/content/en/dir-guest-login.asp http://www.health.state.mn.us/auc/mn270271guide.pdf http://www.insurance.wa.gov/consumers/documents/BRC_Efficiencies_Report.pdf http://www.mckinseyquarterly.com/Overhauling_the_US_health_care_payment_system_2012 http://www.ncvhs.hhs.gov http://www.ncvhs.hhs.gov/100719ag.htm http://www.ncvhs.hhs.gov/100930lt2.pdf http://www.oregon.gov/OHPPR/HEALTHREFORM/AdminSimplification/Docs/FinalReport_AdminSimp_6.3.10.pdf http://www.regulations.gov http://www.sba.gov/sites/default/files/Size_Standards_Table.pdf http://www.ushealthcareindex.com http://www.ushealthcareindex.com/advisorycouncil.php Vol. 76, no. 131 Office of the Federal Register, National Archives and Records Administration 2011-07-08 continuing daily deposited born digital 385 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2011-07-08 P0b002ee180d95bfe 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr08jy11 https://www.govinfo.gov/app/details/FR-2011-07-08 https://www.govinfo.gov/content/pkg/FR-2011-07-08/pdf/FR-2011-07-08.pdf https://www.govinfo.gov/content/pkg/FR-2011-07-08/xml/FR-2011-07-08.xml fdlp 40215 40589 DGPO 2011-07-08 2024-06-04 FR-2011-07-08 machine generated eng FR FR-2011-07-08 76 131