2. Are entities using e-prescribing required to comply with the ACA-mandated CAQH CORE Eligibility & Benefits and laim Status Operating Rules?

No. Per ACA Section 1104, HIPAA-covered entities must comply with all applicable requirements of the ACA-mandated CAQH CORE Eligibility & Benefits and Claim Status Operating Rules. However, CMS did not adopt operating rules for e-prescribing.

3. Does the HHS Final Rule adopting the CAQH CORE Eligibility & Benefits and Claim Status Operating Rules to fulfill the ACA Section 1104 mandate require HIPAA-covered entities to adopt the CAQH CORE requirements for real time processing?

Yes. The ACA-mandated CAQH CORE Eligibility & Benefits and Claim Status Operating Rules require that all entities support real time processing of both the ASC X12N v5010 270/271 and ASC X12N v5010 276/277 transactions. Real time requirements are addressed in the following ACA-mandated CAQH CORE Eligibility & Benefits and Claim Status Operating Rules:

4. What entities are required to certify with HHS that their data and information system are in compliance with the ACA-mandated CAQH CORE Eligibility & Benefits and Claim Status Operating Rules?

Beyond general HIPAA compliance, ACA Section 1104 requires health plans to file a statement with HHS certifying that their data and information systems are in compliance with any applicable standards and associated operating rules for eligibility for a health plan and health claim status.

5. What entities are required to comply with the ACA-mandated CAQH CORE Eligibility & Benefits and Claim Status Operating Rules?

By January 1, 2013, HIPAA-covered entities must meet all technical rule requirements outlined in the CAQH CORE Eligibility & Benefits and Claim Status Operating Rules  that apply to their organizations, except implementation of the rule requirements for Acknowledgements.

6. Does the HHS Final Rule adopting the CAQH CORE Eligibility & Benefits and Claim Status Operating Rules to fulfill the ACA Section 1104 mandate require adoption of the CAQH CORE Rule requirements pertaining to use of Acknowledgements?

7. What CAQH CORE Eligibility & Benefits and Claim Status Operating Rules have been adopted to fulfill the ACA Section 1104 mandate?

The December 2011 HHS Final Rule adopts the use of all the CAQH CORE Operating Rules related to the Eligibility & Benefits and Claim Status transactions to fulfill the ACA mandate, with the exception of rule requirements pertaining to use of Acknowledgements.