HIPAA Resource Center

The only constant in healthcare over the next decade is change.  That’s why it’s important to find a partner who can help you get through these challenges while protecting your revenue streams. Capario is your answer. We can help guide you every step of the way.

Throughout our HIPAA Resource Center you’ll find easy to understand information to help you proactively prepare your organization for these regulatory changes. As always, if you have questions or concerns, you can contact us.

So what are the changes and when are they coming? The most significant regulatory requirements in the next several years include:

• November 5, 2012 – NHPI Final Rule goes into effect
• April 1, 2013 – Compliance date for eligibility and claims status operating rules
• January 1, 2014 – Compliance date for EFT standard, ERA and EFT operating rules
• January 2014 – Stage 2 EHR Meaningful Use attestation begins
• October 1, 2014 – Compliance date to switch from ICD-9 to ICD-10
• November 5, 2014 – NHPI Compliance date for all health plans, with the exception of small health plans
• November 5, 2015 – NHPI Compliance date for small health plans
• January 1, 2016 – Claims attachment standard and operating rules for claims and other transactions begin
• November 7, 2016 – Full implementation date for using NHPI in standard transactions

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Other HIPAA Resources

Learn about HIPAA privacy and security through training games
CMS Regulations and Guidance

Operating Rules for Elig, CSI, EFT and ERA

The purpose of the new operating rules is to reduce inefficient manual processes in healthcare business processes. Improving and standardizing the use of electronic healthcare transactions will save an estimated $12 billion over the next ten years. It will also allow providers to redirect time normally spent on administrative tasks to patient care.

Important dates to know for operating rules
April 1, 2013 – Effective date for implementation of national operating rules for eligibility and claims status
January 1, 2014 – Effective date of implementation of national operating rules for EFT and ERA
January 1, 2014 – Effective date for using EFT standards to transmit electronic healthcare claim payments through the ACH Network
July 1, 2014 – Adoption date for national operating rules for enrollment, prior authorization, and attachments
January 1, 2016 – Effective date for implementation of operating rules for enrollment, prior authorization and attachments

Capario is CORE Phase I and II certified and as such we are fully compliant with the new operating rules for eligibility and claims status today. If you have any questions or concerns about the new operating rules, please contact us at operatingrules@capario.com.

Operating Rules Resources
CORE Mandated Operating Rules
Operating Rules Timeline
Final Rule – Eligibility and Claims Status
Final Rule – EFT and ERA
Operating Rules – Eligibility and Claims Status – Phase I
Operating Rules – Eligibility and Claims Status – Phase II
Operating Rules – EFT and ERA

ICD-10

The purpose of the ICD-10 legislation is to replace the current ICD-9 codeset.  As it is 30 years old, ICD-9 is outdated and inconsistent with today’s medical practice. For more information on ICD-10 and how to prepare, read our white paper Preparing for a future of constantly changing regulations: 5010 and ICD-10 pave the way.

Capario will be prepared to do ICD-10 testing ahead of the compliance dates approved by HHS. Bookmark this page and continue to watch for updates. Learn more about Capario’s ICD-10 readiness.

Important dates to know for ICD-10
Timeline for small providers
Timeline for large providers
Timeline for vendors
Timeline for payers

ICD-10 Resources
Final Rule
CMS ICD-10 Website
CMS ICD-10 FAQs
HIMSS ICD-10 Financial Risk Calculator Self-Assessment
Sign up for ICD-10 updates from CMS

National Health Plan Identifier

The purpose of the NHPI legislation is to remove the many manual processes that plague the current payer ID-based system. Removing the need to collect additional information through calls, faxes, letters, emails and appeals will not only streamline and simplify the routing of healthcare transactions, it is also designed to save billions in healthcare dollars.

Important dates to know for NHPI
November 5, 2012 – Final Rule goes into effect
November 5, 2014 – Compliance date for all health plans, with the exception of small health plans
November 5, 2015 – Compliance date for small health plans
November 7, 2016 – Full implementation date for using HPID in standard transactions

Capario is currently assessing the impact of NHPI on our customers and partners. As with all new industry regulations, we will establish a detailed plan for implementation and will be fully compliant and ready for testing well before the compliance deadlines. For questions or concerns, please contact us at nhpi@capario.com.

NHPI Resources
Final Rule
CMS Fact Sheet
NHPI FAQs