As if the national push for EMRs, the conversion to ANSI X12 5010 and ICD-10 coding and new, more stringent HIPAA privacy and security regulations weren't enough to keep health IT professionals busy for the next several years, the new health insurance reform law requires the adoption of "operating rules" for a series of new and existing HIPAA transactions between 2013 and 2016.

The added responsibility shouldn't be that big of a deal, though, two separate consultants say. That's because various industry stakeholders have had a five-year head start on reaching consensus on such rules.

The Committee for Operating Rules, or CORE, of health insurer advocacy group CAQH (formerly the Council for Affordable Quality Healthcare), has convened representatives of providers, payers, transaction clearinghouses and software vendors to create and test operating rules for transactions regarding claim status and eligibility and benefits determinations. This year, CORE will tackle initial rules on prior authorization and remittance transactions, as well as refine some of the earlier rules.

"CORE has the infrastructure in place to do this," Rachel Foerster, principal at Beach Park, Ill.-based Rachel Foerster & Associates, tells Health Data Management. "It's a well-established, well-vetted, working function."

Pat Kennedy, president of PJ Consulting in Rockville, Md., says that most major private payers, clearinghouses and vendors already support CORE rules. "The marketplace is ready today. I don't think we're going to have a problem moving this forward for 85 to 90 percent of the industry," he says.

For more on HIPAA "operating rules":
- peruse this Health Data Management story

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