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.