- Operating rules were included as a requirement of the Patient Protection and Affordable Care Act of 2010, under section 1104, Administrative Simplification.
- Operating rules are intended to support and enhance the use of the adopted HIPAA standard transactions. They may include certain requirements to help implement the transaction in a more uniform way between health plans and providers, to ensure a more complete set of information, and more consistent use of the adopted standards.
- HHS has adopted operating rules for Eligibility and Benefits and Claim Status (2011), and Electronic Funds Transfer and Electronic Remittance Advice (2013).
- As of 2022, HHS had not adopted Operating Rules for other HIPAA standards, including Benefits Enrollment and Disenrollment, Premium Billing, Health Care Claims, and Prior Authorization.
- CAQH CORE has developed Operating Rules for Premium Payments which are available for voluntary use by covered entities.
- Testing or certification with operating rules is voluntary and available through a vendor contracted to CAQH CORE. There is a fee for certification, however, CAQH CORE maintains free tools to support operating rule implementation. Additionally, CAQH CORE offers educational webinars which are archived on its website.