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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.

 
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
Timetable:
Action Date FR Cite
Interim Final Rule  06/00/2025 
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