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The Implementation Deadline for Federally-mandated CAQH CORE EFT and ERA Operating Rules was January 1, 2014.
Learn more about CAQH CORE resources available to help your organization meet the Patient Protection and Affordable Care Act's operating rule mandate.


CORE Overview Presentation


CORE Provider Presentation

Nationally Mandated Operating Rules Timeline with Associated Resources

The timeline below lists activities and resources related to operating rules required by the Patient Protection and Affordable Care Act (ACA). CAQH CORE activities are italicized.

   KEY: Acronyms included in the timeline are listed at the bottom of this page.
   Activities are arranged chronologically and color-coded related to the ACA Operating Rules for:   
   Eligibility and Claim Status Transactions
   Electronic Funds Transfer (EFT) and Remittance Advice (ERA) Transactions
   Claims or Equivalent Encounter Information, Enrollment/Disenrollment in a Health Plan, Health Plan Premium Payments, Referral Certification and Authorization, and Claims Attachments
   HHS Certification
Date
Activities
Resources
1/1/2016
ACA deadline for the effective date of implementation of national operating rules for Claims or Equivalent Encounter Information, Enrollment/Disenrollment in a Health Plan, Health Plan Premium Payments, Referral Certification and Authorization, and Claims Attachments CMS Summary of Administrative Simplification Provisions in the ACA
7/1/2014
ACA deadline for the adoption of national operating rules for Claims or Equivalent Encounter Information, Enrollment/Disenrollment in a Health Plan, Health Plan Premium Payments, Referral Certification and Authorization, and Claims Attachments CMS Summary of Administrative Simplification Provisions in the ACA
2/19/2014
The NCVHS Subcommittee on Standards holds a hearing on HIPAA and ACA Administrative Simplification

CAQH CORE gives testimony at the NCVHS hearing
CAQH CORE Testimony to NCVHS
1/2/2014
HHS publishes a NPRM [CMS-0037-P] in the Federal Register for Administrative Simplification: Certification of Compliance for Health Plans NPRM Issued by HHS
1/1/2014
ACA deadline for the effective date of implementation of national operating rules for EFT and ERA

ACA deadline for the effective date of using the EFT standards to transmit electronic healthcare claim payments through the ACH Network
CMS Summary of Administrative Simplification Provisions in the ACA
4/19/2013
CMS announces that the Interim Final Rule (CMS-0028-IFC) adopting the CAQH CORE EFT and ERA Operating Rules is a Final Rule that is in effect now. CMS Notice to Industry Adopting EFT & ERA Operating Rules IFC as Final Rule
2/27/2013
The NCVHS Subcommittee on Standards holds a hearing on Electronic Attachments Standards and Operating Rules

CAQH CORE gives testimony at the NCVHS hearing
CAQH CORE testimony to NCVHS
1/2/2013
CMS announces 90-day period of enforcement discretion for compliance with Eligibility and Claim Status Operating Rules CMS Announcement of 90-Day Period of Enforcement Discretion
1/1/2013
ACA deadline for the effective date of implementation of national operating rules for eligibility and claim status CMS Summary of Administrative Simplification Provisions in the ACA
9/28/2012
CAQH CORE distributes a model comment letter regarding the IFR issued on August 10, 2012 CAQH CORE Model Comment Letter to CMS RE: CMS-0028-IFC
9/12/2012
HHS designates CAQH CORE for ACA mandated operating rules NCVHS letter from the Secretary
8/10/2012
HHS issues an IFR regarding Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions IFR Issued by HHS
7/10/2012
CMS announces the Interim Final Rule (CMS-0024-IFC) adopting healthcare EFT standards is a final rule that is in effect now (These Standards influence Operating Rules) CMS announcement of final rule adopting EFT Standards (CMS-0024-IFC)
7/1/2012
ACA deadline for the adoption of national operating rules for EFT and ERA CMS Summary of Administrative Simplification Provisions in the ACA
6/20/2012
The NCVHS Subcommittee on Standards holds a hearing on Administrative Transaction Standards, Code Sets and Operating Rules: Industry Status of Planning, Transitioning and Implementation

CAQH CORE gives testimony at the NCVHS hearing
CAQH CORE written testimony

CAQH CORE presentation
3/7/2012
CAQH CORE distributes a model comment letter regarding the IFR (pertaining to Standards that influence Operating Rules) issued on January 10, 2012 CAQH CORE Model Comment Letter RE: CMS-0024-IFC
3/2/2012
NCVHS sends a letter to the HHS Secretary RE: Claim Attachments

NCVHS sends a letter to the HHS Secretary RE: Administrative simplification provisions addressed in Section 10109 of the ACA
NCVHS letter to HHS RE: Claims Attachments

NCVHS letter to HHS RE: Section 10109 of the ACA
3/2/2012
NCVHS sends a letter to the HHS Secretary RE: Additional analysis of the update and maintenance process for standards and operating rules NCVHS letter to HHS
1/10/2012
HHS issues an IFR regarding Administrative Simplification: Adoption of Standards for Health Care EFT and Remittance Advice IFR Issued by HHS
12/7/2011
HHS adopts the CAQH CORE operating rules regarding eligibility for a health plan and healthcare claim status transactions CMS Notice Regarding HHS Adoption

CAQH press release
12/7/2011
NCVHS sends a letter to the HHS Secretary regarding Administrative Simplification: Recommendation to adopt operating rules to support the Standards for Health Care Electronic Funds Transfers and Health Care Payment and Remittance Advice NCVHS letter to HHS
11/18/2011
The NCVHS Subcommittee on Standards holds hearings on Administrative Simplification under the ACA: Section 10109 of the Affordable Care Act (Enrollment)

CAQH CORE gives testimony at the NCVHS hearings
CAQH CORE testimony to NCVHS
11/18/2011
The NCVHS Subcommittee on Standards holds hearings on Administrative Simplification under the ACA: Standards and Operating Rules Maintenance Process

CAQH CORE gives testimony at the NCVHS hearings
CAQH CORE testimony to NCVHS
11/17/2011
The NCVHS Subcommittee on Standards holds a hearing on Administrative Simplification under the ACA: Claims Attachments

CAQH CORE gives testimony at the NCVHS hearing
CAQH CORE testimony to NCVHS
9/6/2011
CAQH CORE submits a comment letter to CMS regarding the IFR issued on July 8, 2011 CAQH CORE Comment Letter to CMS RE: CMS-0032-IFC
8/22/2011
CAQH CORE distributes a model comment letter regarding the IFR issued on July 8, 2011 CAQH CORE Model Comment Letter to CMS RE: CMS-0032-IFC
8/1/2011
CAQH CORE submits draft operating rules for EFT and ERA to NCVHS CAQH CORE EFT and ERA Operating Rules
8/1/2011
CAQH CORE distributes a request for CORE Participant input on the July 8, 2011 IFR for Eligibility and Claim Status

CAQH CORE and NACHA submit a letter to NCVHS to provide an update on Draft CAQH CORE EFT and ERA Operating Rules
CAQH CORE Request for CORE Participant Input

Supplement - Overview of CAQH CORE Phases I & II Operating Rules

CAQH CORE and NACHA letter to NCVHS
7/8/2011
HHS issues an IFR regarding Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions IFR Issued by HHS
7/1/2011
ACA deadline for the adoption of national operating rules for eligibility and claim status CMS Summary of Administrative Simplification Provisions in the ACA
4/27/2011 - 4/28/2011
The NCVHS Subcommittee on Standards holds a hearing on Administrative Simplification under the ACA: The Acknowledgment Transaction Standard

CAQH CORE gives testimony at the NCVHS hearing
CAQH CORE written testimony

CAQH CORE presentation


4/27/2011 - 4/28/2011
The NCVHS Subcommittee on Standards holds a hearing on Administrative Simplification under the ACA: Maintenance and Modifications to Standards and Operating Rules (the present and the future)

CAQH CORE gives testimony at the NCVHS hearing
CAQH CORE written testimony

CAQH CORE presentation

3/23/2011
NCVHS sends a letter to the HHS Secretary recommending CAQH CORE in collaboration with NACHA as the candidate authoring entity for operating rules for all healthcare EFT and ERA transactions NCVHS letter to HHS
12/3/2010
The NCVHS Subcommittee on Standards holds a hearing on Administrative Simplification under the ACA: Standards and Operating Rules for Eligibility and Claim Status

CAQH CORE provides NCVHS with an update related to the development of operating rules for eligibility and claim status
CAQH CORE written testimony

CAQH CORE oral testimony
(Set audio track to 50:00)

CAQH CORE presentation
12/3/2010
The NCVHS Subcommittee on Standards holds a hearing on Administrative Simplification under the ACA: Standards and Operating Rules for EFT and ERA

CAQH CORE gives testimony to NCVHS related to the development of EFT and ERA operating rules
CAQH CORE written testimony

CAQH CORE oral testimony
(Set audio track to 4:25:30)
11/11/2010 - 12/12/2010
CAQH CORE holds “Tiger Team” calls to collect and share suggestions on enhancements to the CORE Phase I and Phase II rules as recommended in the NCVHS letter to the HHS Secretary Summary of CAQH CORE Rules Work Group Tiger Team calls

Results of CAQH CORE survey on potential enhancements to CORE Phase I and II Operating Rules
9/30/2010
NCVHS sends a letter to the HHS Secretary recommending CAQH CORE as authoring entity for eligibility and claim status operating rules for non-retail pharmacy transactions NCVHS letter to HHS
8/4/2010
CAQH CORE sends a letter to NCVHS regarding Operating Rules for Eligibility and Claims Status CAQH CORE letter to NCVHS
7/21/2010
The NCVHS Subcommittee on Standards holds second day of hearings on Administrative Simplification under the ACA: National Health Plan Identifier and Operating Rules for Eligibility and Claim Status

CAQH CORE gives a follow-up presentation to NCVHS based on its experience developing operating rules
CORE presentation

7/20/2010
The NCVHS Subcommittee on Standards holds its first day of hearings on Administrative Simplification under the ACA: National Health Plan Identifier and Operating Rules for Eligibility and Claim Status

CAQH CORE gives testimony to NCVHS based on its experience developing operating rules
CORE written testimony

CORE presentation

3/23/2010
President Obama signs the ACA into law Public Law 111 - 148 - Patient Protection and Affordable Care Act


Acronyms included in the Timeline:

  • ACA - The Patient Protection and Affordable Care Act
  • ACH - Automated Clearing House
  • CAQH CORE - The CAQH Committee on Operating Rules for Information Exchange
  • CMS - The Centers for Medicare and Medicaid Services
  • EFT - Electronic Funds Transfer
  • ERA - Electronic Remittance Advice
  • HHS - The Department of Health and Human Services
  • IFR - Interim Final Rule
  • NACHA - The Electronic Payments Association
  • NCVHS - The National Committee on Vital and Health Statistics
  • NPRM - Notice of Proposed Rulemaking


Return to the "Mandated Operating Rules" Index Page