Administrative Simplification Basics: Operating Rules

Administrative Simplification Basics Series:

Operating Rules

Did you know that in addition to standards, Administrative Simplification also includes operating rules for electronic transactions? Operating rules for administrative transactions are designed to work in tandem with the standards to make it easier to use them and save the health care community time and money.

Operating rules specify the actions covered entities must take to ensure information is shared smoothly and quickly. Operating rules have been adopted for these transactions:

• Eligibility
• Claims status
• Electronic funds transfer and remittance advice (EFT/ERA)
  

To make sure that the operating rules reflect current business processes, HHSdesignated CAQH CORE to develop and maintain them.

To learn more, watch this introductory video.