Administrative Simplification was introduced as a part of the Health Insurance Portability and Accountability Act and is continuing under the Affordable Care Act' Under ACA, new operating rules were established to streamline administrative processes, increase security of protected health information and promote greater uniformity in the exchange of electronic health care data.
Administrative Simplification can contribute to cost savings and help improve operational efficiencies for your office by:
- Reducing paperwork
- Increasing accessibility of electronic transactions
- Promoting greater accuracy with faster results
Operating Rules
The Committee on Operating Rules for Information Exchange is part of the Council for Affordable Quality Healthcare initiative. CAQH CORE has authored the operating rules, which were implemented in phases for all HIPAA-standard electronic data interchange transactions including:
- Eligibility and Benefits (270/271) and Claim Status (276/277)
- Electronic payment and remittance transactions including 835 Electronic Funds Transfer and 835 Electronic Remittance Advice
- Electronic prior authorizations, referrals, claims and claims attachments
Refer to the Electronic Commerce page for current information on EDI Transactions.
Helpful Links
- Centers for Medicare & Medicaid Services (CMS) website — Additional information may be found in the Regulations and Guidance section, under HIPAA Administrative Simplification.
- CAQH website - For details on the operating rules and related information, refer to the CORE section on the CAQH website.
CAQH CORE is a multi-stakeholder collaboration of more than 130 organizations representing providers, health plans, vendors, government agencies, and standard-setting bodies developing operating rules to help simplify health care administrative transactions.