CAQH CORE Final Model Comment Letter on 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, CAQH CORE has developed a Final Model Comment Letter that both CORE and non-CORE Participants may customize and use as they deem appropriate to submit comments to HHS. The Final Model Comment Letter can be found HERE. It contains key substantive areas for comment identified through a public solicitation for comments (via the Web and in a public call on January 22, 2014) as well as input received on the Draft Model Comment Letter. Comments must be submitted to CMS by March 3, 2014. The Final Model Comment Letter is also available on the CAQH CORE website in the table HERE. For more information on the HHS NRPM and the detailed schedule for CAQH CORE to develop and issue the Model Comment Letter see the initial 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 (Posted on public CAQH CORE website HERE and sent via email) January 13, 2014 January 21, 2014 Open CAQH CORE call on Initial List (Presentation and call recording posted HERE)  January 22, 2014 CORE and non-CORE Participants may attend the call  Draft Model Comment Letter (Posted on public CAQH CORE website HERE and sent via email) February 3, 2014 February 10, 2014 Final Model Comment Letter (Posted on public CAQH CORE website HERE and sent via this email) February 21, 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 PRESS RELEASE: CAQH and Major Health Plans Launch COB Smart

CAQH distributed the following press release today. Contact CAQH at cob@caqh.org for more information. CAQH PRESS RELEASE CAQH and Major Health Plans Launch COB Smart -  A Collaborative Solution to Improve Healthcare Claims Processes COB SmartTM delivers timely and reliable coordination of benefits (COB) information WASHINGTON, DC - February 19, 2014 - CAQH® and a number of major health plans today announced the launch of COB SmartTM, a national coordination of benefits (COB) registry that enables providers and health plans to identify individuals with multiple forms of coverage before care is delivered. As a result, COB claims can be processed correctly the first time. The registry is already identifying COB for more than 100 million patients. COB Smart is unique because it is designed to be an industry-wide, not-for-profit utility that streamlines COB processes for providers and health plans. COB Smart helps ensure that providers receive accurate payments, health plans reduce claim rework, and patients spend less time on registration forms and questionnaires. "We are increasingly looking for ways to integrate technology solutions like COB Smart to streamline the claims process," said Matthew G. Manders, President, Regional and Operations, Cigna Corporation. "Using COB Smart represents a collective commitment by the industry to reduce waste and improve the healthcare experience for customers and healthcare professionals." Not knowing the COB details for a patient can cause significant claims processing inefficiencies, which cost providers and health plans more than $800 million annually. COB Smart helps streamline the claims process by identifying when a patient is covered by more than one health plan and providing critical insight into which health plan pays first. In turn, patients receive the full value of their benefits. COB Smart is being rolled out on a market-by-market basis. The solution is currently live in 15 states; the remainder of the country is scheduled to go live later in 2014. The impact of this solution will amplify throughout the U.S. as more organizations adopt COB Smart. "COB Smart is addressing the frustrations that patients, providers, and health plans sometimes experience with benefit coordination," said Robin Thomashauer, Executive Director of CAQH. "Efficient COB processes are integral to ensuring providers receive the right payment and health plans process the correct claims the first time." CAQH and its member health plans worked together to design COB Smart. Participating health plans include Aetna; AultCare; Blue Cross and Blue Shield of North Carolina; BlueCross BlueShield of Tennessee; CareFirst BlueCross BlueShield; Cigna; Health Net, Inc.; Horizon Healthcare Services, Inc.; Kaiser Permanente; UnitedHealthcare; and WellPoint, Inc., on behalf of its affiliated health plans. Each of these health plans has committed to adopt the solution. COB Smart is the latest CAQH solution introduced to reduce costs and ease administrative processes. The CAQH Universal Provider Datasource (UPD®) is used by 1.2 million providers to share credentialing and other professional information with more than 700 health plans, hospitals and other related organizations. In addition, the CAQH electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollment tool helps providers sign up to receive electronic payments and remittance advice from multiple health plans. Both of these CAQH solutions are available to providers at no charge. CAQH is also leading the Committee on Operating Rules for Information Exchange (CORE®), a national multi-stakeholder collaboration of more than 140 participating organizations working to streamline administrative data exchange and improve payer-provider interoperability. CAQH CORE has been designated by the Department of Health and Human Services (HHS) as the author for federally-mandated operating rules under the Administrative Simplification section of the Patient Protection and Affordable Care Act (ACA). For more information about COB Smart please visit www.caqh.org. About CAQH CAQH serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. CAQH solutions help promote quality interactions between plans, providers, and other stakeholders; reduce costs and frustrations associated with healthcare administration; facilitate administrative healthcare information exchange; and encourage administrative and clinical data integration. Visit www.caqh.org for more information. Follow us on Twitter at @caqh. # # #

Deadline Extension: 2013 Market-based Review of CORE Code Combinations

Storm Extension: 2013 Market-based Review of CORE Code Combinations   DEADLINE:  Due to the major snow and ice storms impacting large portions of the Southeast and Northeast, CAQH® Committee on Operating Rules for Information Exchange (CORE®) today announced a five day extension of the 2013 Market-based Review 60 day submission period.  The new deadline for submission is end of business on Wednesday, February 19, 2014 (initially was February 14, 2014). As per the CAQH CORE Code Combinations Maintenance Process, the CAQH CORE Code Combinations Task Group (CCTG) conducts two types of review and adjustment to the CORE Code Combinations: Compliance-based Reviews and Market-based Reviews. Market-based Reviews occur once a year and for 2013 issuance will consider industry submissions addressing additions and removals to the existing CORE-required Code Combinations for existing CORE-defined Business Scenarios. To satisfy the goals of the CAQH CORE Uniform Use of CARCs and RARCs (835) Rule to support the rule's maintenance requirements and to ensure that the Market-based Review process addresses evolving industry business needs for using the CORE Code Combinations, the CAQH CORE Code Combinations Task Group (CCTG) created the components of the online submission form  The form is being used to collect the necessary input from the industry so thoughtful maintenance can occur.  This document outlines the basic instructions regarding how an entity needs to use the online submission form to submit its code combination recommendations. REVISED DUE DATE: This Market-based Review is to be completed is02/19/2014. WHO CAN SUBMIT: All CORE Participants plus non-CORE Participants that create, use, or transmit HIPAA-covered transactions may submit potential Market-based adjustments via the online Market-based submission form (MBR Form). GETTING STARTED: Eligible entities wishing to participate in the 2013 Market-based Review can begin by completing Part 1 of the MBR Form by clicking the link HERE.   Detailed Instructions for the MBR Form are included to assist in the completion of the MBR Form. If you need additional assistance in navigating the Market-based Review Form or have any questions regarding the 2013 MBR please email core@caqh.org. Additionally, CAQH CORE education sessions will be offered announcing and explaining the MBR submission process. Thank you, CAQH CORE

CAQH CORE Town Hall Call - Feb. 11, 2014 - Register Today

Join Us for the CAQH CORE February Town Hall Call A Free Information Session Open to the Public Tuesday, February 11, 2014 2:00 - 3:00 pm ET    Register HERE There is no fee to attend.      Please join us for our first Town Hall Call of 2014. This 60-minute interactive session will focus on recent CAQH CORE activities which include: Latest Information on ACA Operating Rules Hear insights on the status of industry implementation of mandated Electronic Funds Transfer and Electronic Remittance Advice (EFT & ERA) Operating Rules and see lessons learned gathered from industry implementers Learn about the rule-writing occurring for the third set of ACA Operating Rules, the options being discussed, and how you can get involved Comments on the HHS Certification NPRM Review CAQH CORE activities to prepare comments on the Department of Health & Human Services (HHS) Notice of Proposed Rule Making (NPRM) released on Jan. 2, 2014 Discuss the Draft CAQH CORE model comment letter that was developed based on input from entities like you Note: The draft model comment letter was distributed on Feb. 3, 2014; your comments are requested by Feb. 10, 2014 Information about the CAQH CORE Code Combinations Task Group initiatives All submissions due Feb. 14, 2014, for the Market Based Review. Learn how you can submit your adjustments to the CORE Code Combinations View a summary of the recent Feb. 1, 2014, Compliance-based Review of the CORE Code Combinations CAQH CORE Town Hall Calls provide the public with an update on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. If you have any questions, please contact CORE@caqh.org.

CORE Code Combinations - Updated Version Available for Implementation

Updated Version Available for Implementation: February 2014 CORE Code Combinations v3.0.4 To: All HIPAA Covered Entities and Business Associates    From: The CAQH CORE Code Combinations Task Group Co-Chairs    The purpose of this communication is to announce that an updated version of theCORE-required Code Combinations for the CORE-defined Business Scenarios (CORE Code Combinations) is now available for use with CAQH CORE 360: Uniform Use of CARCs and RARCs Rule. CAQH CORE Rule 360 enables more uniform use of the Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) by targeting a minimum set of common or problematic Business Scenarios along with a maximum specified set of code combinations for each of these Scenarios. The CORE Code Combinations must be updated to align with the current published CARC and RARC lists which are maintained by code committees and updated at least three times per year.   The CORE-required Code Combinations for the CORE-defined Business Scenarios v3.0.4 February 2014 is now available on the CAQH CORE website for use with CAQH CORE 360 Rule. The February 2014 CORE Code Combinationsincludes Compliance-based Adjustments to the CORE Code Combinationsapproved by the CAQH CORE Code Combinations Task Group based on the November 2013 published CARC and RARCs lists. A marked-up version of theFebruary 2014 CORE Code Combinations showing Compliance-based Adjustments between v.3.0.3 and v.3.0.4 is available HERE and a table summarizing the adjustments is available HERE. For more information visit the Ongoing Maintenance of the CORE Code Combinations for CAQH CORE 360 Rule Webpage which is a "one stop shop" for all the necessary tools and information to comply with CAQH CORE 360 Rule and the ongoing maintenance process. The CAQH CORE Code Combinations TaskGroup is in the final steps of preparation for the first Market-based Review of theCORE Code Combinations. CORE Participants are encouraged to get involved with the Task Group. Please do not hesitate to contact core@caqh.org with any additional questions.

CAQH CORE Education Session - Feb. 4, 2014 - EFT and ERA Operating Rules Implementation

CAQH CORE Education Session on EFT and ERA Operating Rules Implementation Industry Implementer Perspectives: Clearinghouse and Provider February 4, 2014 2:00 PM - 3:30 PM ET REGISTER There is no fee to attend.  Join industry implementers for a session centered on implementation of the CAQH CORE EFT & ERA Operating Rules. Hear from a clearinghouse and a provider about how they effectively worked together to implement the EFT & ERA Operating Rules. This advanced session will assist all HIPAA-covered entities in their efforts to operationalize the Rules. Gain valuable insights from InstaMed, a CORE participating organization and the first CORE Phase III certified clearinghouse, about their approach towards execution of the EFT & ERA Operating Rules and how they worked with their trading partners - including health plans and providers. InstaMed will discuss: Implementation preparation and process General considerations and challenges Working with trading partners Best practices and lessons learned You will also hear from a provider, Performance Pediatrics, about implementation considerations and benefits of the CAQH CORE EFT & ERA Operating Rules. Performance Pediatrics will cover topics related to: The importance of EFT & ERA transactions from a provider perspective Implementation planning and challenges Considerations for working successfully with trading partners Benefits: what is being experienced now and what will evolve You will have ample time to participate in Q&A with InstaMed, Performance Pediatrics and CAQH CORE representatives. Who Should Attend All stakeholders that have questions about implementing the EFT & ERA Operating Rules are encouraged to attend. Note: A working knowledge of Federally Mandated EFT & ERA Operating Rules is assumed.  About InstaMed InstaMed has emerged as a leading payments network for the healthcare industry. With its bank partners, InstaMed moves billions of dollars and information on its single, integrated network.  InstaMed is the first Phase III CORE-certified organization and powers healthcare payments for 400+ hospitals, 60,000+ practices/clinics and 100+ billing services nationwide. About Performance Pediatrics Performance Pediatrics is a small primary-care micro practice located in Plymouth, Massachusetts. In a micro practice, two or three providers work without medical assistants; the providers in micro practices see fewer patients a day than most doctors and spend more time with each patient. What we lose in volume we make up for in having low overhead. The result is a patient-focused medical home that not only provides outstanding primary care to our young patients, but also enables the providers to achieve financial stability as well as work-life balance. 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.