Section 1104 of the federal Patient Protection and Affordable Care Act (ACA) includes provisions to adopt “operating rules” to support the adopted HIPAA X12 and NCPDP standards. The National Committee on Vital and Health Statistics (NCVHS) recently recommended to CMS that 1) CAQH CORE be considered as an authoring entity for operating rules for non-retail pharmacy-related eligibility and claim status transactions; 2) CMS adopt CAQH CORE Phase I and Phase II operating rules for non-retail pharmacy eligibility and claim status transactions; and 3) NCPDP be adopted as the operating rule author for pharmacy eligibility transactions, and that the D.0 standard serve as the operating rule for that transaction. NCVHS also requested that CAQH CORE solicit more industry input into the operating rules, and determine if enhancements were feasible, before a final recommendation was sent to the Secretary. The CORE and NCPDP rules are candidates for adoption under this legislation, though no regulation has yet been published.
CAQH/CORE held open teleconferences on Nov. 11 and 12 to discuss possible enhancements to their voluntary rules. A survey to solicit industry responses to the proposed operating rule enhancements is available on the CAQH/CORE website For more information, or to complete the survey, go to the CAQH/CORE website homepage or “feedback period” page. To become a voting member of CAQH, visit the homepage as well.