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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:
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.
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