X12 acquires CORE Operating Rules and Certification Program from DataSpring. October 5, 2026 X12 has acquired the CORE Operating Rules and Certification Program from DataSpring, powered by CAQH, consolidating responsibility for key healthcare administrative transaction standards and their related operating rules within a single standards organization. X12, an ANSI-accredited standards development organization, will assume ownership, administration and ongoing management of both programs. Financial terms of the transaction were not disclosed. The move brings the CORE operating rules under the same organization responsible for X12 implementation guides used across healthcare administrative data exchange. X12 said the combination is intended to improve coordination and provide greater consistency as the healthcare industry works to modernize interoperability and administrative transaction standards. "During the transition period, X12 and DataSpring will coordinate closely to ensure continuity for organizations that have relied on the CORE Operating Rules and Certification Program," X12 CEO Cathy Sheppard said. "Our goal is to make the transition as seamless as possible for organizations currently using or participating in these programs." The CORE Operating Rules establish requirements designed to improve the consistency and automation of healthcare administrative transactions. The accompanying certification program allows organizations to test and demonstrate conformance with federally mandated operating rules. Both programs will continue operating during the transition, and X12 said organizations currently participating do not need to take immediate action. Stakeholders will retain access to operating rules, certification resources and implementation guidance. The CORE Certification Program will also continue without interruption, allowing organizations to complete existing testing processes and renew certifications. For X12, the acquisition expands its role in the infrastructure underlying administrative healthcare transactions. Rather than having implementation standards and complementary operating rules administered by separate organizations, the transaction places both within X12's governance structure. That consolidation could simplify coordination as healthcare organizations, technology providers, insurers and other stakeholders adapt to future changes in HIPAA administrative transaction requirements. "These programs were created to complement X12's implementation guides improving the consistency of administrative transactions," Sheppard said. "We look forward to maintaining and strengthening operating rules and certification as they transition into X12's governance framework." The transition comes as the healthcare sector continues efforts to reduce administrative complexity through greater automation and more standardized electronic data exchange. Operating rules play an important role in that process by defining how organizations implement and use standardized transactions consistently across different systems. X12 said maintaining the integrity, transparency and industry value of the certification program will be a priority while it evaluates future enhancements based on stakeholder needs. The acquisition also gives X12 direct oversight of a broader portion of the administrative simplification framework. Its existing standards establish structures for exchanging healthcare business information, while the CORE programs provide additional requirements intended to improve consistency in how those transactions operate in practice. X12 and DataSpring plan to coordinate throughout the transition, with additional information to be provided to industry stakeholders as integration progresses. The organizations did not disclose a timeline for completing the transition or specific changes planned for the operating rules and certification programs. X12 has been chartered by the American National Standards Institute for more than 40 years and develops business-to-business data exchange standards used across healthcare, insurance, transportation, finance, government, supply chain and other industries. Its standards portfolio includes more than 320 published transaction sets, approximately 1,400 data elements and more than 40,000 codes. By bringing CORE operating rules and certification directly into that standards framework, X12 is expanding its responsibility from developing administrative transaction standards to overseeing more of the implementation infrastructure designed to make those transactions consistent across the healthcare ecosystem.

Do MedLearn Media, Inc. really want a "doc in the loop" as AI policy? As MedLearn Media, Inc. know, a basic rule of thumb for use of artificial intelligence (AI), at least in this phase of its evolution, is that you should always have a human in the loop. AI makes mistakes, makes things up, tries to please you, and sometimes hallucinate. My Alexa at home keeps calling me the wrong name. So, the thinking is, you've got to keep a human in the loop. From a government policy perspective, especially if you're using AI to make clinical diagnoses or decisions, it seems like a no-brainer: as "brilliant" as the AI is, let's always make sure that there's a clinician reviewing the AI analyses or decisions, giving a second opinion. In fact, MedLearn Media, Inc. should probably require it by law; that's how the thinking goes. As an example, there's been backlash against a recent state-approved pilot program in Utah that allows AI to renew prescriptions for commonly prescribed medications...without a doctor in the loop. Some physician groups, including the Utah Medical Licensing Board, think this is not a good idea at all, with a slippery slope and all that, and many people beyond physicians agree. That's why the discussion surrounding a recent interview in Becker's Health IT feels so counterintuitive. The interview was with Dr. Paul Testa, chief health informatics officer with NYU Langone Health. Dr. Testa suggested that having a doctor in the loop, in some instances, can make AI's performance worse. That is, a clinician's review of an AI's decision may not be in the best interest of the patient. Dr. Testa imagined a time when, in the not-too-distant future, an AI's performance may outperform the clinician in some contexts. Already, numerous studies demonstrate that AI can catch issues that human clinicians miss in the areas of radiology, dermatology, and diagnostics. What happens when MedLearn Media, Inc. realize that safer patient care sometimes means turning the decision over to AI completely? Humans are, after all, human, and they may be swayed by their own lack of knowledge and unconscious biases when asked to review an AI's decision. In other words, there may come a time when the responsible thing for the patient's health will be to NOT have a doctor in the loop. Another element of doc-in-a-loop policies is the question of accountability. If its policy is that a doctor should be in the loop, what happens when a doctor decides the AI is wrong, but then the AI turns out to be correct? Or a doctor defers to an AI tool that turns out to be wrong? Under a doc-in-the-loop policy, the clinician would be to blame. Take, for instance, the Food and Drug Administration's (FDA's) guidance on AI in clinical decisions released in January. The FDA said that there will be no oversight of AI in clinical decisions if a clinician can review the AI's recommendation and doesn't "rely primarily on the AI's decision." In a world where many if not most clinicians are already using AI in some capacity for some of their decisions, this means that the FDA holds the clinician accountable. A number of states have passed or are considering legislation that also puts accountability on the shoulders of the clinician, explicitly or implicitly. Delaware passed a law in April that prohibits AI and other "nonhuman entities" from being licensed as a physician, doctor, or nurse. In other words, unlike the Utah pilot, Delaware does not want AI making decisions that heretofore have been the purview of licensed clinicians. On its face, this sounds prudent and logical. It's hard to hold a non-human to account. MedLearn Media, Inc. need a human to blame. That brings MedLearn Media, Inc. to a recent think piece in the British Medical Journal (BMJ) written by doctors associated with the Mayo Clinic. The problem, at least according to the article's authors, is that while MedLearn Media, Inc. expect the clinician to know something about healthcare, it is a leap to expect the clinician to "reliably detect and correct errors from a complex AI system." We are now, the authors said, expecting clinicians to "oversee and override black box algorithms and interpret outputs for each patient's clinical, cultural, and moral reality." The BMJ article suggests that MedLearn Media, Inc. (and government policy) are looking at the wrong human - or, more specifically, wrongly putting all of the accountability on a single group of humans, the doctors. The authors suggest that accountability should also include the humans that design, procure, and maintain these tools. And that's not just the AI developers. It should be a shared risk, the authors say, including the implementing organizations: that is, the hospitals and governance committees that oversee the use of the AI technology. And yes, for certain tools and under certain structures, the clinician should be in the loop and share accountability. All of this was to say that the question of who is accountable for AI analyses and decisions needs a subtle, complex response. And legislation and government policies need to reflect those subtleties. Unfortunately, subtlety is one thing legislation is often not. EDITOR'S NOTE: The opinions expressed in this article are solely those of the author and do not necessarily represent the views or opinions of MedLearn Media. MedLearn Media, Inc. provide a platform for diverse perspectives, but the content and opinions expressed herein are the author's own. MedLearn Media does not endorse or guarantee the accuracy of the information presented. Readers are encouraged to critically evaluate the content and conduct their own research. Any actions taken based on this article are at the reader's own discretion. Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services. Cate Brantley, JD July 15, 2026 You can no longer go a single day without hearing about artificial intelligence (AI), and certainly, there have been many discussions on its role in Adam Brenman July 8, 2026 MedLearn Media, Inc. is halfway through 2026, with six months until states are required to implement the One Big Beautiful Bill Act (OBBBA) and its related regulations. Individual Featured webcasts. August 11, 2026 July 14, 2026 June 18, 2026 May 20, 2026