CMS Adopts Two Operating Rules for ASC X12 Transactions

The Centers for Medicare & Medicaid Services (CMS) posted for public inspection an interim final rule with comment period (IFC) in the Federal Register on June 30 to adopt the first set of operating rules for two of the adopted ASC X12 standards: eligibility for a health plan and “health care claim status” transactions. This IFC is the first in a series of regulations required by Section 1104 of the Affordable Care Act of 2010 over the next five years.

The IFC adopts, with a few exceptions, the existing Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), operating rules for eligibility and claims status transactions, excluding those for retail pharmacy exchanges. Certain elements of the operating rules were excluded from adoption, including the operating rule requirement for standard acknowledgement transactions, because a standard for the acknowledgement must be formally adopted through notice and comment rule making rather than the IFC process. Also not adopted was the CAQH CORE requirement to obtain (and pay for) CAQH CORE specified certification and testing.

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The IFC with comment period may be viewed on the Federal Register’s Electronic Publication Inspection Desk until it is published July 8, after which it will only appear in the Federal Register itself. You have until 5 p.m. (EDT) on Sept. 6 to comment.

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