Yikes! What’s all this about ACA Operating Rules???

Man with Questions
Can you offer real time eligibility and claim status in 20 seconds or less, roundtrip?

Did you know that if you’re a HIPAA-covered entity, you could be faced with hefty fines if you’re not compliant with Phase I of the ACA Operating Rules by April 1, 2013?

If you’re still a little hazy on the ACA Operating Rules requirements, we can help. Regardless of where you’re at now, our deep industry knowledge and experience will help you tackle these requirements like a pro.


The ACA Operating Rules don’t apply to my business.

  • If you’re a HIPAA-covered entity, the ACA Operating Rules apply to you!
  • If you confirm eligibility to your Providers over the phone, you must comply with Real Time Eligibility by January 1, 2013.
  • If you accept claims from your Providers, you must comply with Real Time Claims Status by January 1, 2013.
  • If you’re not already, you must offer EFT and ERA to all providers by January 1, 2014.


  • Phase I – 01/01/13 (Real Time Eligibility and Claims Status)
  • Phase II – 01/01/14 (EFT and ERA)
  • Phase III – 01/01/16 (Claims, COB, Enrollment, Premium Payment, Referral, Auths)

What we offer…

Compliance Services

After quickly assessing your current environment and strategic plans, we will work with your team to evaluate the scope, risk factors, and required actions to comply with all three phases of the ACA Operating Rules mandates. We can take the burden off your team with services customized to your specific needs.

#1: Discovery – operating rules education, review goals, establish a methodology and expected deliverables, evaluate your current technology and application architecture, detailed review of your transaction processes for claims, eligibility, claims status, and claims payment.

#2: Analysis – through a series of interviews and system evaluation, we will complete the following deliverables as required by CAQH CORE to satisfy requirements and prepare for payer certification:
–  Stakeholder and Business Type Evaluation
–  Systems Inventory and Impact Assessment
–  Detailed Gap Analysis
–  System and Process Flow Diagram
–  Code Mapping

#3: Deliverables – onsite presentation of the CORE required deliverables along with a draft project plan and a written assessment report of risk areas, alternatives to consider, and recommendations for next steps and risk mitigation.

Compliance Software

To further accelerate your Phase I compliance efforts, we can integrate an automated software solution with your current core claims transaction system to seamlessly support the mandated real time eligibility and claim status requirements (270/271, 276/277).

Additional Resources: