In a letter to HHS Secretary Kathleen Sebelius, the National Committee on Vital and Health Statistics recommended adoption of specific operating rules to unify financial and administrative electronic transactions, Health Data Management reports.
NCVHS has endorsed Phases I and II eligibility and claims status rules from the Committee on Operating Rules for Information Exchange. The CORE rules come from the Council for Affordable Quality Healthcare, a not-for-profit alliance of health plans and trade associations.
The committee also recommended pharmacy-related operating rules from the National Council for Prescription Drug Programs.
The recommendations will affect health plans, which are required to adopt operating rules by the federal health reform law.
Payers long have used multiple standards for HIPAA transactions but also have developed separate guidelines that kept transactions from being uniform.
Guidelines Already in Use
More than 50 groups have adopted Phase I CORE rules, while 19 organizations are certified for Phase II rules. Phase III rules currently are being designed for additional transactions.
NCVHS Wants Scrutiny
NCVHS told HHS that it must continue to scrutinize the operating rules if they are mandated. It also recommended that HHS require that any companion rules do not conflict with the original regulations (Goedert, Health Data Management, 10/7).