CAQH CORE Education Session - Jan. 28, 2014 - Implementation Considerations for CARCs and RARCs

CAQH CORE Education Session Implementation Considerations for CAQH CORE 360: Uniform Use of CARCs and RARCs Rule January 28, 2014 2:00 PM - 3:30 PM ET REGISTER There is no fee to attend.     Due to popular demand we are pleased to offer another education session focused on the implementation of the Uniform Use of CARCs and RARCs Rule. The main goal of this education session is to discuss tips from industry implementers about executing CAQH CORE 360: Uniform Use of CARCs and RARCs Rule. This education session will also include rule requirements, information about the current Market Based Review of the CORE Code Combinations and ample time to answer your questions about the Rule. Note: A working knowledge of Federally Mandated CAQH CORE EFT & ERA Operating Rules is assumed. In this education session: Hear insights into processes, challenges and best practices for operationalizing the Uniform Use of CARCs and RARCs Rule from CORE participating organization and CORE Code Combinations Task Group member, Michigan Department of Community Health   Get a provider perspective on implementation considerations and approach from another CORE participating organization, Montefiore Medical Center, and find out how providers are working with their trading partners to realize the benefits from implementing this Rule   Receive answers to your questions about CAQH CORE 360: Uniform Use of CARCs and RARCs Rule   Learn more about the current Market Based Review, due by 2/14/14, and how you can submit your suggested adjustments to the CORE Code Combinations   Get more information about the free implementation resources provided by CAQH CORE   Who Should Attend All stakeholders that are currently working towards compliance with the EFT & ERA operating rules or have questions about the CARCs and RARCs Rule are encouraged to attend.    About Montefiore Medical Center As the University Hospital for Albert Einstein College of Medicine, Montefiore is a premier academic medical center recognized among the top hospitals nationally and regionally by U.S. News & World Report for its clinical excellence, scientific discovery and commitment to its community. With four hospitals, 1,491 beds and 90,000 annual admissions, Montefiore is an integrated health system seamlessly linked by advanced technology. State-of-the-art primary and specialty care is provided through a network of more than 130 locations serving over 2 million residents in the Bronx and Westchester County, NY. About Michigan Department of Community Health The Michigan Department of Community Health (MDCH) is one of 18 departments of Michigan state government.  The Department, one of the largest in state government, is responsible for health policy and management of the state's publicly-funded health service systems. About 2 million Michigan residents will receive services this year that are provided with total or partial support from MDCH. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

CAQH CORE Education Session - Jan 28, 2014 - Implementation Considerations for CARCs and RARCs

CAQH CORE Education Session Implementation Considerations for CAQH CORE 360: Uniform Use of CARCs and RARCs Rule January 28, 2014 2:00 PM - 3:30 PM ET REGISTER There is no fee to attend.  Due to popular demand we are pleased to offer another education session focused on the Uniform Use of CARCs and RARCs Rule. The main goal of this education session is to discuss tips on how entities are implementing CAQH CORE 360: Uniform Use of CARCs and RARCs Rule.  This education session will also include implementation considerations, rule requirements, and information about the current Market Based Review of the CORE Code Combinations. Note: A working knowledge of Federally Mandated CAQH CORE EFT & ERA Operating Rules is assumed. In this education session: Receive answers to your questions about CAQH CORE 360: Uniform Use of CARCs and RARCs Rule Hear from specific industry implementers about steps they took to operationalize this Rule     Learn more about the current Market Based Review, due by 2/14/14, and how you can submit your suggested adjustments to the CORE Code Combinations Get more information about the free implementation resources provided by CAQH CORE    Who Should Attend All stakeholders that are currently working towards compliance with the EFT & ERA operating rules or have questions about the CARCs and RARCs Rule are encouraged to attend.    About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

CAQH CORE Public Call - Jan. 22, 2014 - Discussion of HHS NPRM for ACA-mandated Health Plan Certification

CAQH CORE Public Call Discuss initial observations to the HHS Notice of Proposed Rulemaking (NPRM) for ACA-mandated Health Plan Certification January 22, 2014 2:00 PM - 3:00 PM ET REGISTER There is no fee to attend.  Join us for this public call which will discuss an initial list of observations and questions to the HHS NPRM. Section 1104 of the Patient Protection and Affordable Care Act (ACA) mandates a certification process that health plans must complete in order to prove compliance with all existing CAQH CORE Operating Rules and their underlying standards. The Department of Health and Human Services (HHS) released the Notice of Proposed Rule Making (NPRM) on the HHS Health Plan Certification in the Federal Register on January 2, 2014.  The NPRM includes health plan certification requirements for the eligibility, claim status, electronic funds transfers (EFT), and electronic remittance advice (ERA) transactions. CAQH CORE is collecting industry comments and questions on the NPRM and plans to develop a model comment letter reflecting this input, which both CORE and non-CORE Participants may customize and use to submit comments on the NPRM to HHS. During this call, CAQH CORE will share the observations and questions that have been received so far and offer the audience a chance to provide feedback on this list. In this call you will be able to: Discuss the Initial List of observations and questions to inform the draft of the model comment letter. Offer your input and comments on this initial list. Who Should Attend All CORE and non-CORE Participants who would like to participate in discussing the initial list of observations are encouraged to attend. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

Due 01/21/14: Industry Input on Initial Observations on HHS Health Plan Certification NPRM

The Department of Health and Human Services (HHS) released the Notice of Proposed Rule Making (NPRM) on the HHS Health Plan Certification in the Federal Register on January 2, 2014.  Public comments on the NPRM are being accepted through March 3, 2014. Per the CAQH CORE timeline, in February CAQH CORE will issue a Model Comment Letter that both CORE and non-CORE Participants may customize and use as they deem appropriate to submit comments to HHS. To begin the generation of substantive comments on the NPRM, please refer to the initial list of observations and questions regarding potential areas needing clarity, which is available HERE. Your input on the key initial observations is requested, as well as any suggestions for additional areas for comment. Your input on the key comments is requested, as well as any suggestions for additional areas for comment. So that input can be reflected on the CORE public call, comments on the Initial List are due to CAQH CORE by January 21, 2014. Please direct your email with comments in the table in the attached document to Zachary Fithian at zfithian@caqh.org. The List of Initial NPRM Observations is also available on the CAQH CORE website in the table HERE. On January 22, 2014 at 2pm ET, CAQH CORE will hold a public call, open to both CORE and non-CORE Participants, to discuss the Initial List in order to inform the Draft Model Comment Letter. For more information on the HHS NRPM and the detailed schedule for CAQH CORE to develop and issue the Model Comment Letter see the CAQH CORE announcement below. Administrative Simplification: Certification of Compliance for Health Plans The Department of Health and Human Services (HHS) released the Notice of Proposed Rule Making (NPRM) "Administrative Simplification: Certification of Compliance for Health Plans" in the Federal Register on January 2, 2014.  HHS is accepting public comments on the NPRM through March 3, 2014.  The NPRM includes health plan certification requirements for the eligibility, claim status, electronic funds transfers (EFT), and electronic remittance advice (ERA) transactions. It defines two potential certification options for health plans to meet HHS compliance requirements:  Option 1: HIPAA Credential - Under the HIPAA Credential Program it is proposed that health plans will attest to compliance with the HIPAA-mandated standards and operating rules. NOTE:  In order to share comments with HHS on the NPRM, CAQH CORE will actively gather industry comments on the proposed HIPAA Credential Program and the other parts of the NPRM.  Once HHS issues the Final Rule later in 2014, CAQH CORE, as the proposed administrator, would offer the ability to complete the necessary HIPAA Credential documentation. Prior to publication of the Final Rule, the draft HIPAA Credential documentation, as outlined in the NPRM, will be available on the CAQH CORE website.  For more information on Option 1 click HERE.   Option 2: CORE Certification - The NPRM proposes to adopt the existing CORE Certification Program, authored and administered by CAQH CORE. Health plans that successfully complete certification testing with a CORE-authorized testing vendor and submit the required documentation will receive a Phase III CORE Certification Seal demonstrating their compliance. CORE Certification is available now. For more information on CORE Certification click HERE.    OPPORTUNITIES TO SHARE YOUR COMMENTS   Industry stakeholders are encouraged to participate in the CAQH CORE efforts that will be used to collect comments on the NPRM. Based on this industry input, CAQH CORE will develop a model letter that both CORE and non-CORE Participants may customize and use as they deem appropriate in submitting comments on the NPRM to HHS.  The schedule and deliverables related to creating a model letter are:  Deliverable Date of Issue by CAQH CORE Industry Response Due to CAQH CORE  Initial List of NPRM Comments (To be posted on public CAQH CORE website HERE and sent via email) January 13, 2014 January 21, 2014 Open CAQH CORE call on Initial List (Dial-in to be posted on CAQH CORE website HERE; announcement for call will be sent via email)  January 22, 2014 at 2pm ET CORE and non-CORE Participants may attend the call  Draft Model Comment Letter (To be posted on public CAQH CORE website HERE and sent via email) January 29, 2014 February 7, 2014 NOTE: CORE Participant only call may be held on Draft Model Comment Letter.  All CORE Participants will be emailed to determine if a call is needed. CORE Participants should emailCORE@caqh.org if they would like to join such a call.  Final Model Comment Letter (To be posted on public CAQH CORE website HERE and sent via email) February 14, 2014 Any entity can use all or parts of the model comment letter.Comments are due to HHS by March 3, 2014.   This schedule will be available on the CAQH CORE website HERE. The dates will also be on the CAQH CORE calendar which is only accessible to CORE Participants.

HHS Publishes NPRM for Administrative Simplification: Certification of Compliance for Health Plans

Administrative Simplification: Certification of Compliance for Health Plans The Department of Health and Human Services (HHS) released the Notice of Proposed Rule Making (NPRM) "Administrative Simplification: Certification of Compliance for Health Plans" in the Federal Register on January 2, 2014.  HHS is accepting public comments on the NPRM through March 3, 2014.  The NPRM includes health plan certification requirements for the eligibility, claim status, electronic funds transfers (EFT), and electronic remittance advice (ERA) transactions. It defines two potential certification options for health plans to meet HHS compliance requirements:  Option 1: HIPAA Credential - Under the HIPAA Credential Program it is proposed that health plans will attest to compliance with the HIPAA-mandated standards and operating rules. NOTE:  In order to share comments with HHS on the NPRM, CAQH CORE will actively gather industry comments on the proposed HIPAA Credential Program and the other parts of the NPRM.  Once HHS issues the Final Rule later in 2014, CAQH CORE, as the proposed administrator, would offer the ability to complete the necessary HIPAA Credential documentation. Prior to publication of the Final Rule, the draft HIPAA Credential documentation, as outlined in the NPRM, will be available on the CAQH CORE website.  For more information on Option 1 click HERE.   Option 2: CORE Certification - The NPRM proposes to adopt the existing CORE Certification Program, authored and administered by CAQH CORE. Health plans that successfully complete certification testing with a CORE-authorized testing vendor and submit the required documentation will receive a Phase III CORE Certification Seal demonstrating their compliance. CORE Certification is available now. For more information on CORE Certification click HERE.    OPPORTUNITIES TO SHARE YOUR COMMENTS   Industry stakeholders are encouraged to participate in the CAQH CORE efforts that will be used to collect comments on the NPRM. Based on this industry input, CAQH CORE will develop a model letter that both CORE and non-CORE Participants may customize and use as they deem appropriate in submitting comments on the NPRM to HHS.  The schedule and deliverables related to creating a model letter are:  Deliverable Date of Issue by CAQH CORE Industry Response Due to CAQH CORE  Initial List of NPRM Comments (To be posted on public CAQH CORE website HERE and sent via email) January 13, 2014 January 21, 2014 Open CAQH CORE call on Initial List (Dial-in to be posted on CAQH CORE website HERE; announcement for call will be sent via email)  January 22, 2014 at 2pm ET CORE and non-CORE Participants may attend the call  Draft Model Comment Letter (To be posted on public CAQH CORE website HERE and sent via email) January 29, 2014 February 7, 2014 NOTE: CORE Participant only call may be held on Draft Model Comment Letter.  All CORE Participants will be emailed to determine if a call is needed. CORE Participants should emailCORE@caqh.org if they would like to join such a call.  Final Model Comment Letter (To be posted on public CAQH CORE website HERE and sent via email) February 14, 2014 Any entity can use all or parts of the model comment letter.Comments are due to HHS by March 3, 2014.   This schedule will be available on the CAQH CORE website HERE. The dates will also be on the CAQH CORE calendar which is only accessible to CORE Participants.

HHS Publishes NPRM for Administrative Simplification: Certification of Compliance for Health Plans

Administrative Simplification: Certification of Compliance for Health Plans The Department of Health and Human Services (HHS) released the Notice of Proposed Rule Making (NPRM) "Administrative Simplification: Certification of Compliance for Health Plans" in the Federal Register on January 2, 2014.  HHS is accepting public comments on the NPRM through March 3, 2014.  The NPRM includes health plan certification requirements for the eligibility, claim status, electronic funds transfers (EFT), and electronic remittance advice (ERA) transactions. It defines two potential certification options for health plans to meet HHS compliance requirements:  Option 1: HIPAA Credential - Under the HIPAA Credential Program it is proposed that health plans will attest to compliance with the HIPAA-mandated standards and operating rules. NOTE:  In order to share comments with HHS on the NPRM, CAQH CORE will actively gather industry comments on the proposed HIPAA Credential Program and the other parts of the NPRM.  Once HHS issues the Final Rule later in 2014, CAQH CORE, as the proposed administrator, would offer the ability to complete the necessary HIPAA Credential documentation. Prior to publication of the Final Rule, the draft HIPAA Credential documentation, as outlined in the NPRM, will be available on the CAQH CORE website.  For more information on Option 1 click HERE.   Option 2: CORE Certification - The NPRM proposes to adopt the existing CORE Certification Program, authored and administered by CAQH CORE. Health plans that successfully complete certification testing with a CORE-authorized testing vendor and submit the required documentation will receive a Phase III CORE Certification Seal demonstrating their compliance. CORE Certification is available now. For more information on CORE Certification click HERE.    OPPORTUNITIES TO SHARE YOUR COMMENTS   Industry stakeholders are encouraged to participate in the CAQH CORE efforts that will be used to collect comments on the NPRM. Based on this industry input, CAQH CORE will develop a model letter that both CORE and non-CORE Participants may customize and use as they deem appropriate in submitting comments on the NPRM to HHS.  The schedule and deliverables related to creating a model letter are:  Deliverable Date of Issue by CAQH CORE Industry Response Due to CAQH CORE  Initial List of NPRM Comments (To be posted on public CAQH CORE website HERE and sent via email) January 13, 2014 January 21, 2014 Open CAQH CORE call on Initial List (Dial-in to be posted on CAQH CORE website HERE; announcement for call will be sent via email)  January 22, 2014 at 2pm ET CORE and non-CORE Participants may attend the call  Draft Model Comment Letter (To be posted on public CAQH CORE website HERE and sent via email) January 29, 2014 February 7, 2014 NOTE: CORE Participant only call may be held on Draft Model Comment Letter.  All CORE Participants will be emailed to determine if a call is needed. CORE Participants should emailCORE@caqh.org if they would like to join such a call.  Final Model Comment Letter (To be posted on public CAQH CORE website HERE and sent via email) February 14, 2014 Any entity can use all or parts of the model comment letter.Comments are due to HHS by March 3, 2014.   This schedule will be available on the CAQH CORE website HERE. The dates will also be on the CAQH CORE calendar which is only accessible to CORE Participants.

CAQH CORE Training Webinar - Jan. 9, 2014 - Market Based Review for CORE Code Combinations

CAQH CORE Training Market Based Review for CORE Code Combinations January 9, 2014  1:30 PM - 2:30 PM ET REGISTER There is no fee to attend.  Does your organization have adjustments to the CORE Code Combinations? Here is your chance... 2013 MBR: Issued on Dec. 13, 2013; you have until Feb. 14, 2014 to submit your recommendations. CAQH CORE invites you to a training session focusing on the Market Based Review (MBR) of the CORE Code Combinations for CAQH CORE 360: Uniform Use of CARCs and RARCs Rule which is conducted by the CAQH CORE Code Combinations Task Group (CCTG). Market Based Reviews occur once a year and for the 2013 issuance is considering industry submissions addressing code combination (CARC/RARC/CAGC) additions and removals to the current version of the CORE Code Combinations not addressed in Compliance-based updates. The CAQH CORE Code Combinations Task Group created questions posed in the online Market Based Review submission form (MBR Form) to collect the necessary input from the industry so thoughtful maintenance can occur. The online MBR form is to be completed by 5pm ET on 02/14/2014. This training session will provide information regarding the MBR process and instructions on how an entity should complete the online MBR Form to submit its code combination recommendations. Training will cover: CORE Code Combinations Maintenance Process 2013 MBR Scope and Submission Process Demo of MBR submission: Live demo to complete Part 1 of the online MBR Form Demo of MBR submission: Live demo to complete Part 2 of the online MBR Form Who Should Attend All CORE Participants plus non-CORE Participants that create, use, or transmit HIPAA-covered transactions may submit potential Market-based adjustments via the online MBR Form and are encouraged to attend this training session. NOTE: A working knowledge of CAQH CORE 360: Uniform Use of CARCs and RARCs Rule is assumed.  As we will not be going into detail about the requirements for the rule itself or other basic information on this topic, please take the time to listen to our CAQH CORE Uniform Use of CARCs and RARCs Rule webinar HERE or download a PDF version of that presentation HERE. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.