Tentative Agenda

National Committee on Vital and Health Statistics (NCVHS)
Subcommittee on Standards

Hearing on HIPAA and ACA Administrative Simplification

— Operating Rules, Review Committee —

National Center for Health Statistics
3311 Toledo Road, Auditorium A&B
Hyattsville, Maryland  20782

Thursday, February 26, 2015


Printable Acrobat Agenda

Hearing Transcript

Hearing Purposes, Objectives

The purpose of this hearing is to review and discuss the current status of selected administrative simplification topics of interest to NCVHS.

The objectives of this hearing are as follows:

  • Review, discuss and consider for recommendations, the Operating Rules presented for adoption for four HIPAA transactions: Health Care Claims, Enrollment/Disenrollment, Premium Payment, Prior Authorization
  • Discuss and consider suggestions of the Review Committee evaluation criteria for existing standards, code sets, identifiers, and operating rules.

(Unless otherwise noted, each testifier will have 5 minutes followed by Subcommittee Q&A at the end of each panel)

8:30 – 8:45 AM Welcome and Introductions Standards Subcommittee Co-Chairs
  Morning Session: Proposed Operating Rules  
8:45 – 9:45 AM Overview of Proposed Operating Rules Health Care Claims, Prior Authorization, Enrollment/Disenrollment & Premium Payment  
  • Operating Rules Authoring Entity (ORAE)
  • Subcommittee Q&A

Gwen Lohse – CAQH CORE

9:45- 10:45 AM Review of Proposed Operating Rule – Part 1  
  • Health Plan Perspective

Rich Cullen – BCBSA
Sid HebertAHIP

  • Public Program Perspective
  • Medicare
  • Market Place
  • Medicaid

John Evangelist – CMS via phone
Karen Shields- CMS via phone
Melissa MooreheadMPHI

  • Provider Perspective

Peter Basch – ACP
Heather McComas – AMA

  • ASC X12

Stacey Barber


Margaret Weiker

  Subcommittee Q&A  
10:45 – 11:00 AM Break  
11:00 – 11:45 AM Review of Proposed Operating Rule – Part 2  
  • WEDI Perspective

Laurie Darst

  • Employer Perspective

Debra Strickland – Xerox

  • Clearinghouse Perspective

Debbi Meisner – Emdeon

Sherry Wilson – Cooperative Exchange

  • Practice Management System Vendors

Eric Christ – HATA


Subcommittee Q&A

11:45 – 12:00 PM Public Comment   
12:00 – 12:30 PM Subcommittee Discussion and Next Steps   
12:30 – 1:30 PM Lunch   
1:30 – 5:00 PM Afternoon Session: Review Committee Evaluation Criteria and Process   
1:30 – 2:00 PM Review Committee Overview
Background, Role, Purpose, Process

  • Background, Role, Purpose, Process
  • Criteria Principles and Parameters
Standards Subcommittee Co-Chairs
2:00 – 3:30 PM Review Committee Evaluation Criteria & Process  
  • DSMO Perspective

Durwin Day

  • SDO Perspective
    • X12
    • NCPDP
    • HL7

Stacey Barber
Margaret Weiker
John Quinn

  • ORAE Perspective

Gwen Lohse – CAQH CORE

  • ONC

Steve Posnack

  • Industry Perspective
    • WEDI
    • Providers
    • Health Plan

Jean Narcisi
Robert Tennant – MGMA
Gail KocherBCBSA
Sid Hebert – AHIP

  • Payers
  • Public Programs
    • Medicare
    • Medicaid

John Evangelist – CMS via phone
Melissa Moorehead– MPHI

  • Clearinghouses

Debbi Meisner – Emdeon
Sherry Wilson – Cooperative Exchange

3:30 -3:45 PM Break  
3:45 – 4:15 PM Review Committee Evaluation Criteria & Process – Continued

  • Subcommittee Q&A
4:15 – 4:30 PM Public Comment  
4:30 – 5:00 PM Subcommittee Discussion and Next Steps  
5:00 PM Adjournment  


 Proposed Operating Rules – CAQH CORE

  • What are the proposed Operating Rules for claims, prior authorization, enrollment and premium payment?
  • How were the proposed Operating Rules developed?
  • Are there Operating Rules that are common to all transactions? Which are those?
  • What are the Operating Rules that are specific to each transaction?
  • How are Acknowledgments handled in the Operating Rules for these transactions?
  • Have the proposed operating rules been piloted/tested? If yes, what are the results of the pilots/testing?
  • What lessons learned from previously adopted operating rules has or will CAQH CORE apply to the proposed operating rules?

 Proposed Operating Rules – Industry Perspective

     Describe the industry’s perspective on the proposed Operating Rules regarding the following:

  • Business needs of the health care industry the operating rules intend to address.
  • Efficiency improvement opportunities for administrative and/or clinical processes in health care, and strategies to measure impact.
  • Potential impact of the operating rules to various health care entities (providers, payers, etc.) on the daily workflow/transaction process; administrative costs, required capabilities and agility to implement the operating rules changes.
  • Potential emerging or evolving clinical, technical and/or business advances the operating rules intend to address or facilitate.
  • Potential impact and/or improvement to health care related data and/or data infrastructure?
  • If applicable, do they incorporate privacy, security and confidentiality?

 Review Committee Overview

  • Legislative background.
  • Introduction about the Review Committee and Evaluation Criteria (RC).
  • Review Committee Process.
  • The purpose of evaluation criteria (RC).

 Review Committee Evaluation Criteria

  • What suggestions are there for evaluation criteria?
  • Should the RC evaluation criteria be used to evaluate new/proposed standards and operating rules? Please explain.
  • Do you have evaluation criteria that can be used to evaluate standards and operating rules?
  • What evaluation criteria have you seen that are effective? Please explain?
  • What process(s) should be used to evaluate standards and operating rules?

Should you require reasonable accommodation, please contact the CDC Office of Equal Employment Opportunity on (301) 458-4EEO (4336) as soon as possible.

Times, topics, and speakers are subject to change. For final agenda, please call 301-458-4200 at NCHS or visit the NCVHS Home Page at http://www.ncvhs.hhs.gov