Operating Rules Overview
What are Operating Rules?
Operating rules, which are required by the Patient Protection and Affordable Care Act, are defined as “the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications.”
Operating rules set certain requirements for transactions that are covered by HIPAA. They specify the information that must be included when conducting standard transactions, making it easier for providers to use electronic means to handle administrative transactions.
CAQH CORE is the authoring entity of the operating rules currently adopted by HHS.
Introduction to Administrative Simplification (Video)
This 3-minute operating rules video offers a quick overview for providers.
Compliance Schedule
- January 1, 2013: Compliance date for Eligibility of a Health Plan and Health Claim Status
- View the Interim Final Rule and Operating Rules
- January 1, 2014: Compliance date for Health Care Electronic Funds Transfers (EFT) and Remittance Advice (ERA)
- View the Final Rule and Operating Rules for EFT and ERA
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