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:
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 firstname.lastname@example.org.
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
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 As it is 30 years old, ICD-9 is outdated and inconsistent with today’s medical practice.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.
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 email@example.com.
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