Health Plan Certification of Compliance Proposed Rule

The Department of Health and Human Services (HHS) has issued a new proposed rule for public comment, “Administrative Simplification: Health Plan Certification of Compliance“. This rule proposes that controlling health plans (CHPs) must submit documentation that demonstrates compliance with the adopted standards and operating rules for three electronic transactions:

1. Eligibility for a health plan

2. Health care claim status

3. Health care electronic funds transfers (EFT) and remittance advice

The rule proposes that controlling health plans be required to submit documentation on or before December 31, 2015.  This proposed rule would also establish penalty fees for a CHP that fails to comply with the certification of compliance requirements.