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Administrative Simplification

Administrative Simplification was introduced as a part of the Health Insurance Portability and Accountability Act (HIPAA) and is continuing under the Affordable Care Act (ACA). Under ACA, new operating rules are being established to streamline administrative processes, increase security of protected health information and promote greater uniformity in the exchange of electronic health care data.

Administrative Simplification can contribute to cost savings and help improve operational efficiencies for your office by:

  • Reducing paperwork
  • Increasing accessibility of electronic transactions
  • Promoting greater accuracy with faster results

Key Implementation Deadlines

The Committee on Operating Rules for Information Exchange (CORE) is part of the Council for Affordable Quality Healthcare (CAQH) initiative. CAQH CORE has authored the operating rules, which are to be implemented in phases for all HIPAA-standard electronic data interchange (EDI) transactions. Examples of important dates include:

  • Jan. 1, 2013: Operating rules for Eligibility and Benefits (270/271) and Claim Status (276/277)
  • Jan. 1, 2014: Operating rules for electronic payment and remittance transactions including 835 Electronic Funds Transfer (EFT) and 835 Electronic Remittance Advice (ERA)
  • Jan. 1, 2016: Operating rules for electronic preauthorizations, referrals, claims and claims attachments
  • Nov. 7, 2016: Use of Health Plan Identifiers (HPIDs) by covered entities

Helpful Links

Centers for Medicare & Medicaid Services (CMS) website – Additional information may be found in the Regulations and Guidance section, under HIPAA Administrative Simplification.

CAQH website – For details on the operating rules and related information, refer to the CORE section on the CAQH website.

For additional information, articles and announcements about Administrative Simplification and other important initiatives at BCBSMT, please check the Capsule News.

CAQH CORE is a multi-stakeholder collaboration of more than 130 organizations representing providers, health plans, vendors, government agencies, and standard-setting bodies developing operating rules to help simplify health care administrative transactions.

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