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In November 2017, the Centers for Medicare & Medicaid Services (CMS) announced that it would pilot a program to audit health plans’ and clearinghouses’ compliance with HIPAA transactions and code sets.
 
The program, called the HHS Administrative Simplification Optimization Program (ASOP), will include reviews of health plan electronic transactions for compliance with federally mandated provisions, such as the standards and operating rules for electronic remittance advice (ERA).
 
For the compliance review, health plans and clearinghouses will be asked to submit transaction files for review and testing through CMS’ in-house testing system, called the Administrative Simplification Enforcement Testing Tool or ASETT.
                                                                                       
To help you prepare, Zelis Healthcare conducted tests using the ASETT system and prepared a guide with informative tips on navigating the complex CMS system to pre-test your X12 files ahead of the ASOP program launch.


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This guide is for informational purposes only and not for the purpose of providing legal advice. You should contact your attorney to obtain advice with respect to any particular issue or problem.
 

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About the Author:
Matthew Albright, Chief Legislative Affairs Office, Zelis Healthcare.
Matthew has over 12 years of regulatory, political and public affairs experience.           

Prior to joining Zelis, Matthew oversaw the certification program at the Center for Affordable Quality Healthcare (CAQH) and Committee on Operating Rules for Information Exchange (CORE) to ensure conformance with the requirements of the Patient Protection and Affordable Care Act (PPACA).

He also served as Director of the Administrative Simplification Group for the Centers for Medicare & Medicaid Services (CMS) where he was responsible for drafting HIPAA regulations. Matthew is a published author on bioethics, has written numerous state and federal regulations and taught as adjunct faculty at St. Martin’s University and Pierce College in Washington state.