Regulatory Information

Change is inevitable in the coming years for the healthcare industry. HIPAA and Affordable Care Act regulations have resulted in mandates which Office Ally is well aware of. We are dedicated to helping you face and overcome the challenges of compliance.

The Regulatory Information page is where you can come to find the most up to date information on upcoming mandates and requirements all in one place.

Important Dates

  • January 1, 2016 – Enrollment, Prior Authorization and Claims Attachment Operating Rules Compliance date
  • November 7, 2016 – Health Plan ID (HPID) full usage date

Operating Rules

  • CORE Phase I and II: Eligibility (270/271) and Claim Status (276/277)
  • CORE Phase III: EFT and ERA (835) Operating Rules
  • CORE Phase IV: Health Care Claims (837), Health Care Service Review - Request for Review and Response (278), Benefit Enrollment and Maintenance (834), Premium Payment (820)
  • The reason behind the new operating rules for standard transactions is to increase the efficiency of and streamline these processes between providers and payers. The improvement of these processes is estimated to save billions in Healthcare overhead costs over the next decade. The time saved will allow providers to spend less time on administrative processes and more time to dedicate to patient care.
  • Office Ally is CORE Phase I, II and III Certified, which means we are fully compliant with the new operating rules for Eligibility (270/271), Claim Status (276/277), and EFT and ERA (835).
  • For more information about CORE, please visit Core Overview or contact CAQH at (202) 861-6380.

    Important Announcements

    Ability for Providers to Register Physical Address

    With the implementation of the 5010 format, PO or Lock Box addresses are no longer allowed in the Billing Provider loop (CMS-1500 Box 33). To assist users who cannot send both the Billing Provider and Pay To Provider addresses together, Office Ally offers the ability for Providers to register their physical address with Office Ally to meet the 5010 requirement for CMS-1500 Box 33 Billing Provider Address.

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