New ACA administrative simplification rules go into effect Jan. 1
Starting Jan. 1, health plans will be required to support new operating rule standards for insurance eligibility verification and claim status electronic transactions. Once implemented, physician practices are expected to see significant savings through increased efficiency. These operating rules and other administrative simplification requirements were included as part the Affordable Care Act of 2010 (ACA) and were developed by the Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange (CAQH CORE). MGMA staff and members participate in CAQH CORE.
The new operating rules will provide greater uniformity of information and transmission formats so that practices can use one type of request for all insurers rather than being required to use multiple systems. In addition, under the new rules, practices will get a more detailed response when they ask about the status of a claim they have submitted to a health plan.
To prepare for these new operating rules, practice administrators should reach out to their practice management system software vendors to determine if their current software can take advantage of these operating rules and other ACA administrative simplification standards such as electronic funds transfer and electronic remittance advice.
Read more about operating rules or see the CMS administrative simplification resources.
Original article posted by MGMA Washington Connexion 11/14/2012