Public Resource Library

Establishes that the standards and associated operating rules adopted by HHS shall, among other things, require minimal augmentation by paper or other communication, describe all data elements (including reason and remark codes) in unambiguous terms, and prohibit additional conditions except where necessary to implement state or federal law or protect against fraud and abuse. Defines Operating Rules as necessary business rules and guidelines for electronic exchange of information not defined by a standard or its implementation specifications. Requires HHS to adopt a single set of consensus-based operating rules for each transaction for which standard has been adopted. Defines criteria for qualified nonprofit entities to provide recommendations on operating rules (entities such as CAQH). Assigns NCVHS to advise HHS on whether nonprofit entity meets criteria, and whether the recommended operating rules shall be adopted.

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