0938-AV42 202504 Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Administrative Simplification: Modifications of Operating Rules for Eligibility for a Health Plan, Health Care Claim Status and Health Care EFT and ERA Transactions (CMS-0060)

This interim final rule modifies four existing operating rules that are currently adopted for three Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions: Eligibility for a Health Plan, Health Care Claim Status, Health Care Electronic Funds Transfers (EFT) and Electronic Remittance Advice (ERA) transactions.  We are developing this rule, in part, based on a June 2023 recommendation letter from the National Committee on Vital and Health Statistics (NCVHS).  Industry stakeholders informed the contents of the recommendation letter, and based on its assessment of input, the NCVHS recommends that the agency adopt updates to the Council for Affordable Quality Healthcare's (CAQH) Committee on Operating Rules for Information Exchange (CORE) operating rules to support X12 transaction standards.

]]> Other Significant Previously Published in The Unified Agenda Final Rule Stage Undetermined Undetermined Deregulatory 45 CFR 162 Social Security Act, sec. 1173 Pub. L. 104-191 (HIPAA) Pub L 111-148 (ACA), sec. 1104 No Interim Final Rule 12/00/2025 Undetermined None No No No Geanelle Herring Technical Advisor 0938 Centers for Medicare & Medicaid Services CMS 410 786-4466 geanelle.herring@cms.hhs.gov Office of Healthcare Experience and Interoperability, 7500 Security Boulevard, Baltimore MD 21244