#core certification

To certify or not to certify? That is the question. The NPRM assumes that there are 3,000 to 5,000 health plans that will need to comply with the Operating Rules mandate. While the actual number is unknown, it is widely believed that the number of health plans that will need to comply with Operating Rules is currently underestimated. http://www.edifecs.com/e/to-certify-or-not/

Operating Rules - A Strategic Perspective With CORE certification as the baseline requirement, every organization in the transaction trading ecosystem would be held to the same standard. http://www.edifecs.com/e/operating-rules-a-strategic-perspective/

Compliance Strategy - CORE Certification Or HIPAA Credential To demonstrate compliance for Operating Rules, Controlling Health Plans (or CHPs) have two options. These were spelled out in the Notice of Proposed Rule Making or NPRM in January 2014. The first is to prepare for and obtain the CORE certification. The second alternative is to self-attest with the HIPAA credential. As of press time, 174 CHPs have earned CORE certification and CAQH reports around a dozen are in the process of earning their CORE seal. http://www.edifecs.com/e/compliance-strategy-core-certification-or-hipaa-credential/

Tips and Tricks For Operating Rules implementation – Calculating ROI It is a best practice to estimate the ROI on any new project and Operating Rules are no exception. Let’s see how the Operating Rules ROI calculation is going to be helpful in the long run. While employers and insured want to know how this benefits them (lower rates, better services, etc.) it’s also important to measure the savings from this implementation to show the benefits of Operating Rules to your business and to justify funding for future phases of Operating Rules implementation. http://www.edifecs.com/e/tips-and-tricks-for-operating-rules-implementation-calculating-roi/

Tips and Tricks For Operating Rules implementation – Acknowledgements Experts advice that implementing acknowledgements is a best practice. 999 and TA1 acknowledgements inform transactional partners if a specific transaction is syntactically valid and whether errors exist or not. The ability to send and receive acknowledgements provides closure to the communication loop with your trading partners. http://www.edifecs.com/e/tips-and-tricks-operating-rules-implementation-acknowledgements/

Tips and tricks for CORE certification and Operating Rules implementation - Partner Communication It is important to consider how you are going to conduct your business after implementing Operating Rules. One key consideration is retaining existing communication methods so business can continue as usual for trading partners that don’t support CORE communication methods. http://www.edifecs.com/e/tips-and-tricks-for-core-certification-and-operating-rules-implementation-partner-communication/

Tips and tricks for CORE certification and Operating Rules implementation - Update your systems CORE seal or HIPAA credential method help you meet the “first certification” requirements and avoid penalties in 2016 (pending final rule). Tip-3: Update your systems for ongoing compliance with Operating Rules and not just for “First Certification” http://www.edifecs.com/e/tips-and-tricks-for-core-certification-and-operating-rules-implementation-update-your-systems/

Tips and tricks for CORE certification and Operating Rules implementation - Getting Compliant CORE Certification is a time consuming and iterative process. The level of support you receive from the certification testing vendor or your trading partners will depend on the number of entities seeking certification at any given point in time. Start your OR Project As soon as possible. Take a survey on implementation timeline http://www.edifecs.com/e/tips-and-tricks-for-core-certification-and-operating-rules-implementation-getting-compliant/