NCVHS Hearing on
Operating Rules
July 20 - 21, 2010:
July 20, 2010
CORE written testimony
CORE presentation
CORE oral testimony -
(Set audio track to 22:20)
July 21, 2010
CORE presentation
CORE oral presentation -
(Set audio track to 4:28:30)
CAQH follow up letter to NCVHS - 8/4/10
CORE Podcast
Listen here
(Supported by iTunes, QuickTime, Real Player)
CORE Phase II
Committed Organizations:
Are You Ready to Submit
Your Phase II Pledge?
THE PHASE II RULES
STATE ACTIVITIES
CORE State Activity and Federal HITECH Alignment
UPCOMING CORE PRESENTATIONS:
CAQH Administrative Simplification Conference
9/22/10
CORE Phase II 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. The CORE Phase II rules will be updated during Q3-2010 to address HIPAA 5010 requirements.
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 to view, print, or download the document(s). View the CORE Phase II Glossary (coming soon) for terms related to the CORE Phase II rules.
The Complete Set of CORE Phase II Rules and Policies
CORE Policies (200-205)
201: Pledge
Goal: Demonstrates public support for CORE and commitment to become certified.
- CORE Phase II Master Test Suite
- CORE Master Test Bed Data - Excel
Goal: For each stakeholder type that can receive CORE certification (health plan, vendor, clearinghouse and large provider), Test Suite provides an objective, standardized method to conduct non-exhaustive testing for each Phase II rule.
CORE Operating Rules* (250, 258-260, 270)
250: Claims Status Rule
Goal: Promotes increased availability and usage of the claims status transaction through application of Phase I infrastructure rules to the 276/277 claims status transactions, including rules for real-time and batch response times, system availability, connectivity, and acknowledgements.
258: Normalizing Patient Last Name Rule
Goal: Provides enhanced patient matching and better information on why a match did not occur in an eligibility request.
259: AAA Error Code Reporting Rule
Goal: Provides enhanced patient matching and better information on why a match did not occur in an eligibility request.
260: Data Content (270/271) Rule
Goal: Provides reporting of patient liability information (remaining deductible amount, plus static co-pay and co-insurance information) in response to a generic or explicit eligibility inquiry; along with 39 additional service type codes beyond the nine service type codes provided in Phase I.
270: Connectivity Rule
Goal: Provides a comprehensive “Safe Harbor” connectivity rule to facilitate connectivity standardization and interoperability across healthcare information exchange, including message envelope standards and metadata requirements.
- XML Schema Specification (normative)
- Web Services Definition Language (WSDL) Specification (normative)
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.
* Enhancing/expanding upon Phase I rules
Now is the time to begin participating in developing the CORE Phase III rules. To join the more than 100 industry stakeholders collaborating on the development of CORE Phase III rules, click here to download a CORE Participant Application Form. For more information, please contact CAQH at (202) 861-1492.







