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Last Modified: 9/29/2019 Location: FL, PR, USVI Business: Part A, Part B

Affordable Care Act - Operating Rules - Requirements for Phase II and Phase III Compliance for Batch Processing

The Centers for Medicare & Medicaid Services (CMS) is in the process of implementing operating rules adopted under Section 1104 of the Affordable Care Act (ACA). The Secretary of the Department of Health & Human Services (HHS) named the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) as the authoring entity of the phase I, II, and III operating rules. The operating rules are intended to provide additional direction and clarification to the electronic data interchange (EDI) standard adopted under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
CMS is currently in the process of implementing the batch requirements for the phase II rules for the claim status inquiry and response, and health care claim payment advice.
HIPAA transactions are referred to in the following manner:
276: ASC X12 health care claim status request
277: ASC X12 health care information status notification
835: ASC X12 health care claim payment/advice
Change request (CR) 9358 requires the MACs to implement a solution to comply with this rule including the use of X.509 client certificates over Secure Socket Layer (SSL) effective April 1, 2017. The solution must be able to receive and post the batch 276/277 and 835 claim payment advice transactions using the public internet. In order to be able to perform these transactions the trading partners must be in compliance with HTTPS CAQH CORE rules. Click here external pdf file for information on the CAQH CORE Connectivity Rule 270 version 2.2.0. For additional information on the CAQH CORE rules click here external link.
First Coast Service Options Inc. (First Coast) has made updates to its EDI enrollment procedures, forms, and trading partners’ management system for connectivity using the HTTPS CAQH CORE requirements.
Please note that enrollment for these two transactions are optional and must be at the trading partner level. Providers can continue to use their current method of transmission for these and any other EDI transactions.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.