CORE Overview Presentation
CORE Provider Presentation
CAQH CORE Phase I Operating Rules
Phase I
Use of the CORE Phase I rules/policies is voluntary and open to all organizations with an interest in administrative data exchange.
Organizations must sign a binding pledge to adopt, implement and comply with CORE Phase I rules. A CORE-authorized testing vendor must certify that their systems are CORE compliant within 180 days of signing the pledge.
CORE certification is tailored for providers, health plans, vendors and clearinghouses. Organizations that do not create, send or transmit data can sign the pledge and receive a CORE Endorser seal.
Below are the documents required to complete the CORE Phase I rules certification process. Please click the link(s) to view, print or download the document(s). Click CORE Phase I Glossary for terms related to CORE Phase I rules.
Complete Set of CORE Phase I Policies and Rules
View a single document with the complete set of CORE Phase I Policies and Rules.
CORE Phase I Policies (100-105)
CORE Phase I Glossary for terms related to CORE Phase I rules.
CORE Phase I Operating Rules (150-157)
151: Real Time Acknowledgements
154: Eligibility (270-271) Data Content Rule
155: Eligibility_Benefits Batch Response Time Rule
156: Eligibility_Benefits Real-Time Response Time Rule
Phase I: Certification Test Suite
Archive: The Phase I and Phase II CAQH CORE policies and rules were updated in 2011 to reflect HIPAA 5010 requirements and associated errata. The CORE Phase I and Phase II Rules 5010 Adjustment Summary and the complete set with tracked changes for substantive HIPAA v5010 to the HIPAA 4010 version of the CORE Phase I Operating Rules are available for review.
Trading Partner Testing and Voluntary CORE Certification
For more information about the CORE Phase I Rules, CORE Phase I certification or applying for a CORE seal, please contact CAQH at (202) 861-1492 or email CORE.
To view the CORE Phase II rules click here.
Visit the CAQH CORE Trading Partner Testing Readiness Page. Organizations that are ready to test operating rules implementation with trading partners are encouraged to add a contact to the new page highlighting readiness for the January 1, 2013 Eligibility and Claim Status Operating Rules implementation deadline.