- Operating rules for HIPAA standard transactions were added as a requirement of the Patient Protection and Affordable Care Act of 2010 (ACA), under section 1104, Administrative Simplification.
- Operating rules are intended to support and enhance the use of standard transactions. They include requirements to help implement the transaction in a more uniform way between health plans and providers and ensure a more complete set of information in the response.
- The EFT/ERA rules support the uniform use of combinations for certain Claim and Remark Codes (CARCs and RARCs), as well as use of certain standard data elements for enrolling providers
- In 2013, HHS adopted CORE Operating Rules for EFT and ERA, which were incorporated by reference at §162.920.
- Prior versions of the adopted operating rules for EFT and ERA Enrollment are available on the CAQH CORE Mandated Operating Rules website and are incorporated by reference at § 162.920.
- Updated and new CORE Operating Rules for ERA were recommended for Federal adoption by the National Committee of Vital Health and Statistics (NCVHS) to the Department of Health and Human Services (HHS) in June 2023.
- Testing or certification with the operating rules is voluntary and available through CORE. CORE maintains free tools to support operating rule implementation. Additionally, CORE offers educational webinars on its website.