CAQH CORE Upcoming November Education Sessions

Upcoming CAQH CORE November Events Mark Your Calendar Are you on track for EFT/ERA compliance? All HIPAA covered entities must comply with ACA-mandated Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Operating Rules byJanuary 1, 2014. The compliance deadline is less than 10 weeks away.  We hope you can attend these upcoming CAQH CORE Education Sessions focused on implementation considerations for EFT & ERA Operating Rules to receive information relevant to your EFT & ERA implementation and have your questions answered in time before this deadline. Both calls will include speakers from entities whose implementations are underway. CAQH CORE 360 Rule: Uniform Use of CARCs and RARCs  Implementation Considerations For CARCs and RARCs Tuesday, November 5, 2013 | 2 - 3:30 pm ET Guest speakers: Health plan, vendor and/or provider implementers CAQH CORE EFT and ERA Operating Rules Implementation Lessons Learned from Industry Implementers Tuesday, November 12, 2013 | 2 - 3:30 pm ET Guest speakers: Health plan, vendor and/or provider implementers  _______________________________________________________________    CAQH CORE 360 Rule: Uniform Use of CARCs and RARCs Implementation Considerations For CARCs and RARCs Tuesday, November 5, 2013 2 - 3:30 pm ET Guest speakers: Health plan, vendor and/or provider implementers Register for this event HERE for free  This education session will discuss the requirements, maintenance process, implementation considerations and other essential information your organization needs in order to be compliant with Operating Rule 360: the Uniform Use of CARCs and RARCs rule. You will hear from industry implementers about steps their organization is taking towards implementation of this Rule as well as CORE Operating Rules in general. There will be substantial time for Q & A. ____________________________________________________________     CAQH CORE EFT and ERA Operating Rules Implementation Lessons Learned from Implementers Tuesday, November 12, 2013 2 - 3:30 pm ET Guest speakers: Health plan, vendor and/or provider implementers Register for this event HERE for free  This education session will offer insights into the implementation considerations, challenges, best practices and lessons learned for implementation of the EFT and ERA Operating Rules from entities whose implementations of these rules are in progress. Speakers will discuss how they are ensuring their EFT and ERA processes are in place and resources they found valuable during implementation. Ample time will be provided for Q & A

CAQH CORE and Edifecs Webinar - Oct. 23, 2013 - Planning for conformance with EFT & ERA Operating Rules through voluntary CORE Certification

CAQH CORE and Edifecs Webinar featuring Humana Planning for conformance with EFT & ERA Operating Rules through voluntary CORE Certification October 23, 2013 2:30 PM - 4:00 PM ET REGISTER There is no fee to attend.  Join CAQH CORE and Edifecs, with special guest Humana, to learn how you can prepare for compliance with the January 1, 2014 ACA-mandated Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Operating Rules, and demonstrate your conformance with the rules through voluntary CORE Certification. This program will provide ample time for audience Q&A.  In this session you will be able to: Learn more about voluntary CORE Certification and how it can help your EFT & ERA Operating Rules implementation efforts. View a demonstration from Edifecs of their CORE-authorized testing platform. Hear from Humana - the first health plan CORE-certified for the EFT & ERA Operating Rules - about implementation considerations, resources, best practices and lessons learned for seeking voluntary CORE Certification and implementing the EFT & ERA Operating Rules in general. Participate in Q&A with Edifecs, Humana and CAQH CORE. Panelists Vijay Bhuttar - Product Management, Edifecs Shruti Ramamurthy - Senior Business Analyst, Edifecs  Kim Peters - HIPAA EDI Program Manager, Humana Who Should Attend All stakeholders interested in learning how they can plan for and test their compliance with EFT & ERA Operating Rules are welcome to attend. This session is designed to assist representatives of health plans, clearinghouses and vendors who would like to find out more about voluntary CORE Certification. A working knowledge of CAQH CORE EFT & ERA Operating Rules is assumed.   About Edifecs Edifecs is the first CORE-authorized testing vendor. More than 35 health plans, large provider groups and health information technology vendors have used Edifecs' on-line CORE Certification Testing Platform to demonstrate their conformance with CAQH CORE Operating Rules. Edifecs is an industry leader since 1996. Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information between health plans, hospitals and other healthcare organizations, while enabling compliance with current mandates, including HIPAA, Operating Rules and ICD-10. About Humana Humana is celebrating 50 years of providing personalized and exceptional service at every level, with services to enhance the wellness of each employee no matter what stage of life. Humana's solutions range from Commercial, Individual and Medicare to Specialty Benefits and Well-being Solutions. Humana ranks 79 on Fortune 500 with revenues of $34 billion and total assets of approximately $18 billion. 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.

CAQH CORE and ASC X12 Education Session - Oct. 15, 2013 - Compliance with the ERA Standard and EFT & ERA Operating Rules

CAQH CORE and ASC X12 Joint Education Session  Compliance with the ERA Standard and  EFT & ERA Operating Rules October 15, 2013 2:30 PM - 4:00 PM ET REGISTER There is no fee to attend.  Please join us for this third webinar in a series of CAQH CORE Education sessions with ASC X12, featuring special guest Aetna. This will be an "Open Mic" session specifically designed to answer your frequently asked questions about compliance with the ERA Standard (ASC X12 v5010 835) and the Electronic Funds Transfer (EFT) & Electronic Remittance Advice (ERA) Operating Rules. This joint CAQH CORE and ASC X12 education session will: Provide detailed information about federally-mandated aspects of the ERA Standard Address some of the major challenges around what a HIPAA covered entity needs to do in order to be compliant with the ERA standard Review the multi-stakeholder processes required for success Offer insights into the challenges, best practices and lessons learned for implementation of the ERA Standard and the EFT & ERA Operating Rules The second half of this session will be dedicated to Q&A. Please come prepared to ask your pressing questions about the ERA Standard and EFT & ERA Operating Rules. Attendees are also encouraged to submit their questions during registration. 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.

Horizon Healthcare Services, Inc. Among Growing Number of Healthcare Organizations to Achieve Voluntary CAQH CORE Operating Rules Certifications

CAQH distributed the following press release today. Contact CAQH at (202) 861-1492 for more information. CAQH PRESS RELEASE Horizon Healthcare Services, Inc. Among Growing Number of Healthcare Organizations to Achieve Voluntary CAQH CORE Operating Rules Certifications First Regional Health Information Organization and First-Ever Phase III CORE Certifications Awarded as Certification Queue Builds WASHINGTON, DC - October 9, 2013 - The CAQH® Committee on Operating Rules for Information Exchange (CORE®) today announced that Horizon Healthcare Services, Inc., New Jersey's oldest and largest health insurer, has earned voluntary CORE Certification for its Phase I and Phase II CAQH CORE Operating Rules implementation. Nearly 70 organizations and products have voluntarily achieved one or more phases of CORE Certification. The Phase I and Phase II CAQH CORE Operating Rules support electronic eligibility and claim status inquiries, streamlining and bringing uniformity to these essential administrative transactions between healthcare providers and health plans. In addition, the rules simplify interoperability for all trading partners. "Providers and patients want and need to know the patient cost of a particular medical procedure or visit in real time," says Mark Barnard, senior vice president, service division, Horizon Healthcare Services, Inc. "Since implementing and becoming certified on the CAQH CORE rules, we are able to bring more clarity to financial aspects of health encounters. Our members and providers are now able to have more informed conversations about billing, and we are working toward a more efficient process that reduces administrative costs for everyone in the payment cycle." The CORE Certification achievement applies to Horizon's network of more than 33,000 doctors and health care professionals, 74 hospitals, and its 3.7 million members. "As a longtime participant in the CAQH CORE rule-writing process, Horizon is a leader in the movement to take wasteful cost and needless frustration out of the healthcare system," says CAQH CORE Board Chair George Conklin, CIO, CHRISTUS Health. "These certifications bring substantial benefits to the hospitals, healthcare systems, physician offices, and other providers caring for Horizon members. They verify that Horizon has successfully implemented the rules to give providers electronic access to real-time, robust eligibility and claim status information." The value of CORE Certification accelerates as more participants in the data exchange use the rules, and additional announcements by CAQH CORE indicate growing end-to-end implementation. HEALTHeNET, the administrative side of the Western New York health information exchange (HIE), HEALTHeLINK, is the first HIE to achieve Phase I and Phase II CORE Certification for its clearinghouse service. In addition, Cigna, a global health service company, has earned Phase II CORE Certification, and RelayHealth has achieved Phase II CORE Certification for its RelayClearance™ Plus vendor product. Another milestone for the CORE Certification program, InstaMed has become the first organization to earn Phase III CORE Certification, achieving the clearinghouse distinction for the InstaMed Network. In addition, Humana has become the first health plan to achieve Phase III CORE Certification. The Phase III CAQH CORE Operating Rules make it easier for providers to enroll in and benefit from Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). Health plans that have achieved one or more phases of CORE Certification currently cover more than 120 million individuals. A number of healthcare organizations have recently committed to achieving CORE Certification, or additional phases of CORE Certification, in the near future. Committed health plans include MVP Health Care (Phase I and II), Aultcare (Phase III), and Blue Cross and Blue Shield of Nebraska (Phase III). Committed clearinghouses include ClaimRemedi for its ClaimRemedi Clearinghouse (Phase I), and vendor commitments include Pay-Plus® Solutions, Inc. for its Pay-Plus® Direct product (Phase III) and RelayHealth for its RelayPayer Connectivity Services (Phase III). Organizations that do not create, transmit, or use the administrative transactions addressed by the CAQH CORE Operating Rules can demonstrate support for CAQH CORE by becoming a CORE Endorser. SunCoast RHIO, a clinically focused Regional Health Information Organization, and emids Technologies are the latest organizations to endorse CAQH CORE. Together, the Phase I, II, and III CAQH CORE Operating Rules, most of which have been adopted under federal law implementing the Patient Protection and Affordable Care Act (ACA), are estimated to save as much as $15 billion over 10 years. Certification accelerates the return on investment by promoting broader use of the operating rules, which drives value for all trading partners in the data exchange. In addition, organizations continue to see value in the CAQH CORE voluntary certification process because it imposes accountability and ensures alignment with all CAQH CORE-authored operating rules, including those mandated by law and those not adopted as part of ACA, as well as with the underlying standards. Entities that create, transmit, or use the administrative transactions in accordance with the CAQH CORE Operating Rules may become CORE-certified. The voluntary CORE Certification process begins with testing implementation by an independent CAQH CORE-authorized testing vendor, such as Edifecs. Once successful implementation is demonstrated, CAQH certifies and awards voluntary CORE Certification Seals. CAQH CORE regularly offers webinars and provides resources and tools to help organizations implement the CAQH CORE Operating Rules.

CAQH CORE and State Medicaid Agencies Education Session - Oct. 10, 2013 - Operating Rule Implementation

CAQH CORE Joint Education Session with State Medicaid Agencies and Supporting Organizations Operating Rule Implementation: Road to compliance and lessons learned October 10, 2013 1:30 PM - 3:00 PM ET REGISTER There is no fee to attend.  Hear from featured State Medicaid agencies about their implementation of both the first set (Eligibility & Claim Status) and second set (Electronic Funds Transfer & Electronic Remittance Advice) of the CAQH CORE Operating Rules. These are real case studies from real world implementers that will benefit all stakeholders in their implementation planning and execution. In this session you will be able to Learn about implementation considerations, including preparation and planning, as these State Medicaid Agencies worked towards compliance with the first two sets of the CAQH CORE Operating Rules Find out how key issues were resolved and challenges overcome during implementation of the Operating Rules Hear about lessons learned and future considerations that can assist you in your own implementation process Participate in Q&A with representatives of the State Medicaid Agencies, three of which are CORE participants Featured Medicaid Agencies and Supporting Organizations Michigan Public Health Institute (MPHI) New Mexico Human Services Department Xerox Government Healthcare Solutions Michigan Department of Community Health Missouri Department of Social Services Who Should Attend All stakeholders interested in learning more about implementation of the CAQH CORE Operating Rules for both Eligibility & Claim Status and Electronic Funds Transfer & Electronic Remittance Advice are encouraged to attend. A working knowledge of the CAQH CORE Operating Rules is assumed.   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.

Updated Version Available: October 2013 CORE Code Combinations v3.0.3

Updated Version Available for Implementation: October 2013 CORE Code Combinations v3.0.3 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 v3.0.3 October 2013 is now available on the CAQH CORE website for use with CAQH CORE 360 Rule. The October 2013 CORE Code Combinationsincludes Compliance-based Adjustments to the CORE Code Combinationsapproved by the CAQH CORE Code Combinations Task Group based on the July 2013 published CARC and RARCs lists. A marked-up version of the October 2013 CORE Code Combinations showing Compliance-based Adjustments between v.3.0.2 and v.3.0.3 is available HERE and a table summarizing the adjustments is available HERE. CAQH CORE 360 Rule is part of the ACA mandated CAQH CORE EFT & ERA Operating Rules which all HIPAA covered entities are required to implement byJanuary 1, 2014. The October 2013 CORE Code Combinations is the third of regular version updates to the CORE Code Combinations for use with CAQH CORE 360 Rule. By January 2014, entities should have an established process and policy for implementing the regular updates to the CORE Code Combinations.   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 Task Group 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.

CAQH CORE Upcoming October Education Sessions

Upcoming CAQH CORE October Events Mark Your Calendar 90 Days To Compliance! Are you ready? Please join us for these upcoming CAQH CORE Education Events to learn how your organization can be better prepared to meet the ACA-mandated Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Operating Rules January 2014 Compliance Deadline: CAQH CORE Joint Education Session with State Medicaid Organizations Operating Rule Implementation: Road to compliance and lessons learned Featuring - Representatives from State Medicaid Organizations Thursday, October 10, 2013 | 1:30 - 3:00 pm ET CAQH CORE and ASC X12 Joint Education Session In-depth look at EFT and ERA Operating Rules Tuesday, October 15, 2013 | 2:30 - 4:00pm ET  ___________________________________________________________________    CAQH CORE Joint Education Session with State Medicaid Organizations Operating Rule Implementation: Road to compliance and lessons learned Thursday, October 10, 2013 | 1:30 - 3:00 pm ET Register for this event HERE for free  Featuring: Michigan Public Health Institute (MPHI) New Mexico Human Services Department Xerox Government Healthcare Solutions Michigan Department of Community Health Missouri Department of Social Services This education session presents real case studies from real world implementers that will benefit all stakeholders interested in learning about implementation of the CAQH CORE Operating Rules. Hear from the featured State Medicaid Organizations about their experiences as they successfully implemented the Operating Rules to meet compliance deadlines. Learn how key rule requirements were addressed and issues resolved during implementation. Take advantage of their lessons learned and challenges overcome so you too are prepared for compliance with the Operating Rules. There will be ample time provided to ask questions to the experts from the State Medicaid Organizations and CAQH CORE. _____________________________________________________________     CAQH CORE and ASC X12 Joint Education Session In-depth look at EFT and ERA Operating Rules Tuesday, October 15, 2013 | 2:30 - 4:00pm ET Register for this event HERE for free  Join CAQH CORE and ASC X12 for an in-depth presentation on the EFT and ERA Operating Rules. Learn about the ERA standard in detail from ASC X12, including its rationale and scope, as well as its key impact for different stakeholders. Understand the requirements, implementation considerations and other essential information your organization needs in order to meet the upcoming January 1, 2014ACA-mandated deadline for compliance with the EFT and ERA Operating Rules. Substantial time will be given to ask questions to knowledgeable ASC X12 and CAQH CORE representatives.