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HHS/CMS | RIN: 0938-AV42 | Publication ID: Fall 2024 |
Title: 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) | |
Abstract:
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. |
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Agency: Department of Health and Human Services(HHS) | Priority: Other Significant |
RIN Status: Previously published in the Unified Agenda | Agenda Stage of Rulemaking: Final Rule Stage |
Major: Undetermined | Unfunded Mandates: Undetermined |
CFR Citation: 45 CFR 162 | |
Legal Authority: Social Security Act, sec. 1173 Pub. L. 104-191 (HIPAA) Pub L 111-148 (ACA), sec. 1104 |
Legal Deadline:
None |
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Timetable:
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Regulatory Flexibility Analysis Required: Undetermined | Government Levels Affected: None |
Federalism: No | |
Included in the Regulatory Plan: No | |
RIN Data Printed in the FR: No | |
Agency Contact: Geanelle Herring Technical Advisor Department of Health and Human Services Centers for Medicare & Medicaid Services Office of Healthcare Experience and Interoperability, MS: S2-26-17, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-4466 Email: geanelle.herring@cms.hhs.gov |