On January 2, 2014, the Department of Health and Human Services (HHS) published a Notice of Proposed Rulemaking (NPRM or “proposed rule”) that would require a controlling health plan (CHP) to submit information and documentation demonstrating that it is compliant with certain standards and operating rules adopted by the Secretary of HHS under the Health Insurance Portability and Accountability Act (HIPAA). The program proposed in the NPRM is referred to as the ACA-mandated HHS Certification of Compliance.
The January 2, 2014 NPRM proposed that the CORE HIPAA Credential would be administered by CAQH CORE and would demonstrate that a CHP has:
- Attested to compliance with the HIPAA-mandated standards and associated operating rules for the eligibility, claim status, electronic funds transfers (EFT), and electronic remittance advice (ERA) transactions AND
- Conducted a certain level of testing with trading partners.
NOTE: According to the Centers for Medicare & Medicaid Services website, “CMS is currently developing a second proposed rule [regarding the ACA-mandated HHS Certification of Compliance program] that would revise the initial proposed provisions in response to public feedback received through the rulemaking process.”
As changes in policy could occur through the rulemaking process, CAQH CORE will finalize the HIPAA Credential forms and provide further guidance, as appropriate, once HHS publishes a final rule on the ACA-mandated HHS Certification of Compliance program. See draft HIPAA Credential forms here. These forms are currently a draft and CAQH CORE will not accept these forms until finalized after publication of a final rule.