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Operating Rules

What are Operating Rules?

Operating rules, which are required by the Patient Protection and Affordable Care Act, set certain requirements for transactions that are covered by HIPAA.  They specify the information that must be included, making it easier for providers to use electronic means to handle standard transactions.


CAQH CORE is the authoring entity of the operating rules currently adopted by the U.S. Department of Health and Human Services.


This 3-minute operating rules video from CMS offers a quick overview.



The following are external links that will lead you away from the Department of Health Care Services website:


 Compliance Schedule


Affordable Care Act

Federal Register: Operating Rules Eligibility and Claims Status

Federal Register: Operating Rules Electronic Funds Transfers and Remittance Advice



Last modified on: 5/30/2017 9:46 AM