ACA Section 1104 requires the HHS Secretary to adopt and regularly update three sets of operating rules for the HIPAA-mandated healthcare administrative transactions:

Under the HIPAA Administrative Simplification provisions, health plans are required to have the capacity to accept and/or send a standard transaction that is otherwise conducts but does not currently support electronically. This requirement applies to all HIPAA-mandated transaction standards.

As the ACA Administrative Simplification provisions build on and update the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), ACA Section 1104 requires all HIPAA-covered entities to comply with the ACA-mandated standards and applicable operating rules by their compliance dates.

ACA Section 1104 requires all HIPAA covered entities to comply with the ACA-mandated operating rules. The CMS website provides charts to help organizations determine whether an organization or individual is a HIPAA covered entity.

Yes.

As the ACA Administrative Simplification provisions build on and update the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), ACA Section 1104 requires all HIPAA-covered entities to comply with the ACA-mandated CAQH CORE Operating Rules for Eligibility

As the ACA Administrative Simplification provisions build on and update the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), ACA Section 1104 requires all HIPAA-covered entities to comply with the ACA-mandated CAQH CORE Operating Rules for Eligibility

On September 12, 2012, HHS issued a letter concurring with the NCVHS recommendation to designate CAQH CORE as the authoring entity for the remaining ACA-mandated operating rules. From December 2013 – September 2015, the CAQH CORE Participating Organizations used the open CAQH CORE rules-making process to produce a set of operating rules for consideration to fulfill the ACA Section 1104 third set.

Yes. In August 2012, HHS issued an Interim Final Rule adopting the CAQH CORE Payment & Remittance Operating Rules to fulfill the ACA Section 1104 mandate, with the exception of rule requirements pertaining to use of Acknowledgements.

Yes. In December 2011, HHS adopted the CAQH CORE Eligibility & Benefits and Claim Status Operating Rules to fulfill the ACA Section 1104 Federal mandate, with the exception of rule requirements pertaining to use of Acknowledgements.