Operating Rules Overview

Operating Rules Overview
A closed book with a ribbon bookmark

What are Operating Rules?

Operating rules, which are required by the Patient Protection and Affordable Care Act, are defined as “the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications.”

Operating rules set certain requirements for transactions that are covered by HIPAA. They specify the information that must be included when conducting standard transactions, making it easier for providers to use electronic means to handle administrative transactions.

CAQH CORE is the authoring entity of the operating rules currently adopted by HHS.

thumbnail image of Introduction to Adminstrative Simplification Video

Introduction to Administrative Simplification (Video)

This 3-minute operating rules video offers a quick overview for providers.

Compliance Schedule

  • January 1, 2013: Compliance date for Eligibility of a Health Plan and Health Claim Status
  • January 1, 2014: Compliance date for Health Care Electronic Funds Transfers (EFT) and Remittance Advice (ERA)

Pages in Operating Rules: 

Keep Up to Date!

Sign up for Administrative Simplification Email Updates and follow us on Twitter, and check out our Resources and FAQs.

For More Information 

Page Last Modified:
01/10/2024 03:21 PM