CAQH CORE Phase II Operating Rules
Use of the CORE Phase II rules/policies is voluntary and open to all organizations with an interest in administrative data exchange.
The Phase II rules build on the Phase I rules, with additional rules for patient identifiers, patient accumulators, claims status and connectivity. The Phase II rules also require patient financial responsibility for an increased number of service codes.
Organizations must sign a binding pledge to adopt, implement and comply with CORE Phase II rules. A CORE-authorized testing vendor must certify that 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 II rules certification process. Click the link(s) to view, print or download the document(s). View the CORE Phase II Glossary for terms related to the CORE Phase II rules.
Complete Set of CORE Phase II Policies and Rules
View a single document with the complete set of CORE Phase II Policies and Rules.
CORE Phase II Policies (200-205)
CORE Phase II Glossary for terms related to CORE Phase II rules.
CORE Phase II Operating Rules (250, 258-260, 270)
- Phase II: Certification Test Bed Data
- XML Schema Specification (normative)
- Web Services Definition Language (WSDL) Specification (normative)
Archive: The CORE Phase I and Phase II 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 II Rules, CORE Phase II certification or applying for a CORE seal, please contact CAQH at (202) 861-1492 or email CORE.
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.