January 1, 2013 is the deadline for adoption of CAQH CORE Operating Rules for Eligibility and Claim Status for all HIPAA-covered entities. Healthcare organizations need to take necessary steps to ensure compliance.
The Patient Protection and Affordable Care Act has specified new requirements pertaining to HIPAA transactions to be carried out by the CAQH CORE alliance. Effective January 1, 2013, all HIPAA-covered entities must adopt the Operating Rules for Eligibility and Claim Status.
These mandates are materially different from previous ones. The CAQH CORE rules specify two transaction-enveloping methodologies, Soap XML and HTTP MIME; transaction content rules, applicable to 270/271; and response time and system availability. The goal of these new mandates is to increase the interoperability of all healthcare organizations, reduce errors, and make transferring information simpler.
However, there are also challenges associated the adoption of these standards. A major challenge for healthcare entities adopting these mandates will be the added strain on existing technical infrastructures. Most EDI translators are designed to generate and parse transactions. CORE mandates focus on transaction enveloping and real-time response. This, in turn, adds technical complexity, uncertainty, and cost to the compliance process.
"Smart Data Solutions understands the challenges associated with adopting CAQH CORE rules. In response, we developed a simple, automated solution that ensures complete adherence to CORE standards and operating rule for the 270/271 and 276/277 transaction sets," affirms Pat Bollom, Smart Data Solutions' co-founder.
Smart Data Solutions is a claims processing company providing customized CAQH CORE solutions. Their solution provides eligibility and benefit extraction and data population/conversion of 270/271 as well as claim status data extraction and population/conversion of 276/277 based on content requirements set forth within the testing process.
With their solution, Smart Data is seeking to greatly simplify compliance while reducing costs. In addition to compliance, Smart Data provides web based portal access that helps reduce call center calls while improving provider relations for their clients. Smart Data's clients also receive 18-month storage of 270/271 and 276/277 data, transaction content development consistent with client system requirements, and request and response display for credentialed users via Smart Data's popular Quick Claim portal.