CAQH CORE Announces Launch of Market-based Review for CORE Code Combinations

2013 Market-based Review of CORE Code Combinations   The CAQH® Committee on Operating Rules for Information Exchange (CORE®) today announced the launch of the 2013 Market-based Review.  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. DUE DATE: This Market-based Review is to be completed by 5pm ET on 02/14/2014. 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 emailcore@caqh.org.   Additionally, CAQH CORE education sessions will be offered announcing and explaining the MBR submission process. Thank you, CAQH CORE

CAQH CORE Open Mic Session with CMS OESS - Dec. 17, 2013 - EFT & ERA Operating Rules Implementation and Compliance

CAQH CORE Open Mic Session with CMS OESS EFT & ERA Operating Rules Implementation and Compliance December 17, 2013 3:00 PM - 4:00 PM ET REGISTER There is no fee to attend.   As your organization works towards compliance with the Jan 1, 2014 deadline forACA-mandated Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Operating Rules, please join us for this last Q&A session of 2013. The key focus of this webinar will be an Open Mic to enable you to ask your questions about EFT & ERA Operating Rules implementation. Staff from CMS' Office of E-Health Standards and Services (OESS) will be present to address compliance questions. You will be able to pose questions via web and phone during this event. You are also encouraged to submit your questions during registration. Special Guest Panelist Matt Albright, Director, Administrative Simplification Group, CMS OESS Who Should Attend All stakeholders currently working towards compliance with the EFT & ERA Operating Rules are encouraged to attend. A working knowledge of Federally Mandated EFT & ERA Operating Rules is assumed. About CMS OESS CMS' Office of E-Health Standards and Services is the U.S. Department of Health and Human Services' (HHS) component that enforces compliance with HIPAA transaction and code set regulations. 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.

Taking Advantage of New EFT & ERA Mandates: Providers - Contact Your Health Plans

Taking Advantage of New EFT & ERA Mandates: Providers - Contact Your Health Plans Are you or do you know a provider organization that would benefit from transitioning to electronic payments? CAQH CORE is pleased to announce the release of a new tool to assist providers that want to transition from paper checks to electronic funds transfer (EFT) payments: a Sample Provider EFT Request Letter a provider can email to health plans or use as talking points for a phone call with health plan contacts to request payment via EFT, as well as EFT & ERA Operating Rule implementation status. The Affordable Care Act (ACA) requires that as of January 1, 2014 all HIPAA covered health plans must offer to providers an electronic payment option via the newly mandated Healthcare EFT Standard (i.e., NACHA CCD+). Thus, by this date, providers are encouraged to request EFT payment from health plans. There are many reasons providers should consider transitioning to EFT payments, including: Faster payment and remittance advice processing Reductions in phone calls to health plans Time savings associated with manual processes such as sorting mail, opening envelopes, posting the checks, depositing the checks, and ultimately reconciling the paper remittance advice with the patient accounts Lower risk of lost or stolen checks Furthermore, the ACA-mandated EFT & ERA Operating Rules support more efficient provider use of both EFT payments and ERAs. The rules address market needs such as more standardized, electronic provider enrollment in EFT and ERA and easier reassociation of EFTs and ERAs. As of January 1, 2014, health plans must have a process in place to offer the benefits of the mandated Operating Rules to providers. Therefore, CAQH CORE has developed this sample letter for providers wishing to enroll in EFT payments and receive an update on a health plan's EFT & ERA Operating Rule implementation. This new tool complements the existing Sample Provider EFT Reassociation Data Request Letter, which providers may use to contact their financial institution(s) regarding EFT.

Reminder: CAQH CORE Education Session Tomorrow - Dec.12, 2013 - Panel Discussion on EFT & ERA Operating Rules Implementation

REMINDER CAQH CORE Education Session on  EFT & ERA Operating Rules Implementation Panel Discussion with Industry Implementers December 12, 2013 2:00 PM - 3:30 PM ET REGISTER There is no fee to attend.  Is your organization on track to comply with the January 1, 2014 deadline for the federally mandated CAQH CORE Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Operating Rules?  Do you have questions about EFT and ERA implementation? Do you need information about how to work with your trading partners? Please join us for our last implementer-focused session of the year, which is designed as a panel discussion among HIPAA covered entities, with the second half of the session allocated for Q&A with the panelists. Featured panelists Margaret Richardson from Health Net Cate McConnell from RelayHealth Mike Olson from Fifth Third Bank These panelists will discuss the process their organizations are undertaking to implement the EFT & ERA Operating Rules, and share details about how they are successfully collaborating with their trading partners towards compliance. Gain valuable insights from them about: Implementation planning and considerations Challenges and resolutions Determining role of trading partners Useful Implementation resources Technical issues when adopting both the new EFT standard and the ERA This information and more will assist all HIPAA covered entities working towards implementing the EFT & ERA Operating Rules. Who Should Attend All stakeholders currently working towards compliance with the EFT and ERA Operating Rules are encouraged to attend. Note: A working knowledge of Federally Mandated EFT & ERA Operating Rules is assumed.    About Health Net Health Net, Inc. provides health and wellness benefits and services through its subsidiaries to approximately 5.3 million individuals across the country through group, individual, Medicare, Medi-Cal, and the Department of Defense, including TRICARE and Veterans Affairs programs. It also offers options for prescription drug benefits with Health Net's mail order pharmacy program, and a widespread offering of ancillary products. Behavioral health services are offered through Managed Health Network (MHN), Health Net's behavioral health subsidiary. MHN also offers Employee Assistance Programs, well-being programs and other workplace solutions. About RelayHealth RelayHealth is a recognized leader in developing and supporting key improvements in healthcare IT. Over the past three decades, it helped pioneer the patient-friendly paper bill, electronic communications with providers and payers, and the virtual online business office. As McKesson's connectivity business, RelayHealth streamlines communications between patients, providers, payers, pharmacies, pharmaceutical manufacturers, and financial institutions by supplying solutions that improve clinical communication, accelerate care delivery, and drive cash collection. For more information, visit RelayHealth at www.relayhealth.com. About Fifth Third Bank For over 150 years, Fifth Third has been providing quality financial products and services to its customers. Fifth Third has $126 billion in assets and operates 18 affiliates with 1,326 full-service Banking Centers and 2,374 ATMs in Ohio, Kentucky, Indiana, Michigan, Illinois, Florida, Tennessee, West Virginia, Pennsylvania, Missouri, Georgia and North Carolina. Based on its rich history of performance and customer service, the Bank has received numerous accolades for the way it operates across its four main businesses: Commercial Banking, Branch Banking, Consumer Lending, and Investment Advisors. 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 - Dec.12, 2013 - Panel Discussion on EFT & ERA Operating Rules Implementation

CAQH CORE Education Session on  EFT & ERA Operating Rules Implementation Panel Discussion with Industry Implementers December 12, 2013 2:00 PM - 3:30 PM ET REGISTER There is no fee to attend.  Is your organization on track to comply with the January 1, 2014 deadline for the federally mandated CAQH CORE Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Operating Rules?  Do you have questions about EFT and ERA implementation? Do you need information about how to work with your trading partners? Please join us for our last implementer-focused session of the year, which is designed as a panel discussion among HIPAA covered entities, with the second half of the session allocated for Q&A with the panelists. Featured panelists Margaret Richardson from Health Net Cate McConnell from RelayHealth Mike Olson from Fifth Third Bank These panelists will discuss the process their organizations are undertaking to implement the EFT & ERA Operating Rules, and share details about how they are successfully collaborating with their trading partners towards compliance. Gain valuable insights from them about: Implementation planning and considerations Challenges and resolutions Determining role of trading partners Useful Implementation resources Technical issues when adopting both the new EFT standard and the ERA This information and more will assist all HIPAA covered entities working towards implementing the EFT & ERA Operating Rules. Who Should Attend All stakeholders currently working towards compliance with the EFT and ERA Operating Rules are encouraged to attend. Note: A working knowledge of Federally Mandated EFT & ERA Operating Rules is assumed.    About Health Net Health Net, Inc. provides health and wellness benefits and services through its subsidiaries to approximately 5.3 million individuals across the country through group, individual, Medicare, Medi-Cal, and the Department of Defense, including TRICARE and Veterans Affairs programs. It also offers options for prescription drug benefits with Health Net's mail order pharmacy program, and a widespread offering of ancillary products. Behavioral health services are offered through Managed Health Network (MHN), Health Net's behavioral health subsidiary. MHN also offers Employee Assistance Programs, well-being programs and other workplace solutions. About RelayHealth RelayHealth is a recognized leader in developing and supporting key improvements in healthcare IT. Over the past three decades, it helped pioneer the patient-friendly paper bill, electronic communications with providers and payers, and the virtual online business office. As McKesson's connectivity business, RelayHealth streamlines communications between patients, providers, payers, pharmacies, pharmaceutical manufacturers, and financial institutions by supplying solutions that improve clinical communication, accelerate care delivery, and drive cash collection. For more information, visit RelayHealth at www.relayhealth.com. About Fifth Third Bank For over 150 years, Fifth Third has been providing quality financial products and services to its customers. Fifth Third has $126 billion in assets and operates 18 affiliates with 1,326 full-service Banking Centers and 2,374 ATMs in Ohio, Kentucky, Indiana, Michigan, Illinois, Florida, Tennessee, West Virginia, Pennsylvania, Missouri, Georgia and North Carolina. Based on its rich history of performance and customer service, the Bank has received numerous accolades for the way it operates across its four main businesses: Commercial Banking, Branch Banking, Consumer Lending, and Investment Advisors. 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.

Reminder: CAQH CORE and NACHA Education Session Today - Dec. 4, 2013 - Implementation of the EFT Standard and EFT & ERA Operating Rules

REMINDER CAQH CORE and NACHA Joint Education Session Implementation of the EFT Standard and EFT & ERA Operating Rules December 4, 2013 2:00 PM - 3:30 PM ET REGISTER There is no fee to attend  Join guest speakers from Aultcare and Bank of America in this education session focused on implementation of the EFT Standard and EFT & ERA Operating Rules. This webinar will offer the audience implementation considerations from health plan and financial institution perspectives. Get information and guidance your organization needs to be compliant with the EFT & ERA Operating Rules by theJanuary 1, 2014 deadline Featured Panelists: Priscilla Holland from NACHA Raza Fayyaz from Aultcare Curtis Crispin from Bank of America Bob Bowman from CAQH CORE In this session: Hear highlights of the Healthcare EFT standard from NACHA Key requirements for January 1st deadline  Background and overview of NACHA's 2013 ACH CCD+ updates, and how they affect your organization  Best practices and lessons learned from organizations that have already implemented the EFT Standard Receive implementation insights from CORE participating health plan, Aultcare Roles and responsibilities of a Health Plan for compliance Implementation preparation and planning for the EFT Standard and EFT & ERA Operating Rules Lessons learned and tips for successful EFT & ERA Operating Rules implementation Find out how CORE participating financial institution, Bank of America, is working with health plans and providers Actions taken by the bank to support the healthcare industry's adoption of the EFT Standard and EFT & ERA Operating Rules What are some best practices for Providers and Health Plans to adhere to when working with their banks Who Should Attend: All stakeholders currently working towards compliance with the EFT & ERA operating rules are encouraged to attend Note: A working knowledge of Federally Mandated EFT & ERA Operating Rules is assumed About NACHA - The Electronic Payments Association NACHA is mandated by Federal regulation as healthcare's EFT standard organization and its ACH CCD+ as a Federally required healthcare EFT standard. NACHA manages the development, administration, and governance of the ACH Network, the backbone for the electronic movement of money and data. As a not-for-profit association, NACHA represents more than 10,000 financial institutions via 17 regional payments associations and direct membership. To learn more, visithttps://healthcare.nacha.org/. About Aultcare Founded in 1985 and located in Canton, Ohio, Aultcare is one of the largest hospital-based Preferred Provider Organizations in the Midwest, with a 97 percent customer retention rate. Aultcare administers payment of benefits such as medical, dental, vision, short-term disability, workers' compensation and flexible spending accounts. Benefit plans include: Preferred Provider Organization (PPO), traditional and Point of Service (POS) plans. Additionally, Aultcare manages a subsidiary company as a licensed Health Maintenance Organization (HMO). About Bank of America Bank of America is one of the world's leading financial institutions, serving individuals, small- and middle-market businesses, large corporations, and governments with a full range of banking, investment management and other financial and risk management products and services. Since the beginning of 2010, we have made significant progress transforming the company into a simpler, more efficient enterprise. We serve approximately 51 million consumers, clients and small businesses. 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.

Reminder: CAQH CORE and NACHA Education Session Today - Dec. 4, 2013 - Implementation of the EFT Standard and EFT & ERA Operating Rules

REMINDER CAQH CORE and NACHA Joint Education Session Implementation of the EFT Standard and EFT & ERA Operating Rules December 4, 2013 2:00 PM - 3:30 PM ET REGISTER There is no fee to attend  Join guest speakers from Aultcare and Bank of America in this education session focused on implementation of the EFT Standard and EFT & ERA Operating Rules. This webinar will offer the audience implementation considerations from health plan and financial institution perspectives. Get information and guidance your organization needs to be compliant with the EFT & ERA Operating Rules by theJanuary 1, 2014 deadline Featured Panelists: Priscilla Holland from NACHA Raza Fayyaz from Aultcare Curtis Crispin from Bank of America Bob Bowman from CAQH CORE In this session: Hear highlights of the Healthcare EFT standard from NACHA Key requirements for January 1st deadline  Background and overview of NACHA's 2013 ACH CCD+ updates, and how they affect your organization  Best practices and lessons learned from organizations that have already implemented the EFT Standard Receive implementation insights from CORE participating health plan, Aultcare Roles and responsibilities of a Health Plan for compliance Implementation preparation and planning for the EFT Standard and EFT & ERA Operating Rules Lessons learned and tips for successful EFT & ERA Operating Rules implementation Find out how CORE participating financial institution, Bank of America, is working with health plans and providers Actions taken by the bank to support the healthcare industry's adoption of the EFT Standard and EFT & ERA Operating Rules What are some best practices for Providers and Health Plans to adhere to when working with their banks Who Should Attend: All stakeholders currently working towards compliance with the EFT & ERA operating rules are encouraged to attend Note: A working knowledge of Federally Mandated EFT & ERA Operating Rules is assumed About NACHA - The Electronic Payments Association NACHA is mandated by Federal regulation as healthcare's EFT standard organization and its ACH CCD+ as a Federally required healthcare EFT standard. NACHA manages the development, administration, and governance of the ACH Network, the backbone for the electronic movement of money and data. As a not-for-profit association, NACHA represents more than 10,000 financial institutions via 17 regional payments associations and direct membership. To learn more, visithttps://healthcare.nacha.org/. About Aultcare Founded in 1985 and located in Canton, Ohio, Aultcare is one of the largest hospital-based Preferred Provider Organizations in the Midwest, with a 97 percent customer retention rate. Aultcare administers payment of benefits such as medical, dental, vision, short-term disability, workers' compensation and flexible spending accounts. Benefit plans include: Preferred Provider Organization (PPO), traditional and Point of Service (POS) plans. Additionally, Aultcare manages a subsidiary company as a licensed Health Maintenance Organization (HMO). About Bank of America Bank of America is one of the world's leading financial institutions, serving individuals, small- and middle-market businesses, large corporations, and governments with a full range of banking, investment management and other financial and risk management products and services. Since the beginning of 2010, we have made significant progress transforming the company into a simpler, more efficient enterprise. We serve approximately 51 million consumers, clients and small businesses. 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.