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 |
|---|---|---|
| 02/24/2020 | CAQH CORE, on behalf of the CAQH CORE Board, submits a letter to the HHS Secretary in response to the NCVHS recommendation on adoption of a set of prior authorization and connectivity operating rules. | CAQH CORE Board Letter to HHS |
| 10/4/2017 | HHS publishes withdrawal notice for Certification of Compliance Proposed Rule. | |
| 7/26/2016 | CAQH CORE, on behalf of the CAQH CORE Board, submits a letter to the HHS Secretary in response to the NCVHS recommendation on adoption of the Phase IV Operating Rules. | CAQH CORE Board Letter to HHS on Phase IV |
| 7/6/2016 | NCVHS sends letter to the HHS Secretary with recommendations on the proposed Phase IV Operating Rules. | NCVHS Letter to HHS Secretary on Phase V Operating Rules |
| 3/31/2016 | CAQH CORE, on behalf of the CAQH CORE Board, submits a letter to the NCVHS Chair urging NCVHS to recommend adoption of the Phase IV Operating Rules to the HHS Secretary. | CAQH CORE Board Letter to NCVHS on Phase IV Operating Rules |
| 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 NOTE: Section 1104 of the ACA includes an adoption date of 7/1/2014 and effective date of 1/1/2016 however, HHS has not yet adopted operating rules or issued guidelines regarding the compliance timeframe for these transactions. |
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 NOTE: Section 1104 of the ACA includes an adoption date of 7/1/2014 and effective date of 1/1/2016 however, HHS has not yet adopted operating rules or issued guidelines regarding the compliance timeframe for these transactions. |
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
