Nationally Mandated Operating Rules & Activites 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
02/24/2020 CAQH CORE, on behalf of the CAQH CORE Board, submits a letter to the NCVHS on federal adoption of a set of prior authorization and connectivity operating rules. CAQH CORE Board Letter to NCVHS
10/4/2017 HHS publishes withdrawal notice for Certification of Compliance Proposed Rule.

Certification of Compliance Withdrawal Notice
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

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