Health and Human Services (HHS) has issued proposed regulations for health plans to certify compliance with HIPAA’s electronic transaction standards and operating rules. Health plans would certify compliance by obtaining one of two credentials from the Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange (CAQH CORE). The proposed rule would also implement the per covered life, per day civil penalties for health plans that fail to certify compliance.
The deadline for certification, originally set for December 31, 2013, was delayed two years to December 31, 2015.
Under Health Care Reform, HHS must adopt standards and operating rules that HIPAA covered entities must use when conducting specified electronic transactions. In addition, health plans must certify that they are in compliance with these standards and rules. Please note that all HIPAA covered entities must comply with the operating standards and rules, but only health plans must certify that they are in compliance.
Health plans should also note that the delay in certifying compliance does not mean they can delay actual compliance with the HIPAA standards and rules. Thus far, HHS has issued transaction standards and operating rules for three electronic transactions, which are listed below along with their respective compliance dates.
- health plan eligibility (January 1, 2013)
- health care claim status (January 1, 2013)
- electronic funds transfers with remittance advice (EFT/ERA) (January 1, 2014)