CORE Phase II Rules

Working through the Phase II Subgroups, CORE participants have created draft Phase II rules. Each rule is under review by its appropriate Work Group. The Subgroups will take into consideration any feedback from the Work Groups and the recently completed Phase II straw poll process when finalizing the rules.

The Phase II rules build on the CORE 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. CORE Phase II voting is scheduled to begin by the end of Q1 2008 (click link below for voting process information). CAQH expects to announce Phase II certification testing beginning at the end of Q3 2008 and into 2009.

Phase II Rules – Scope and Draft Rules

Policies (Will be same approach as Phase I with appropriate adjustments)

• Pledge
  Goal: Public support for CORE and commitment to become certified.
• Phase II Test Suite for Certification and Testing (conducted by independent entities)
  Goal: For each stakeholder type that can receive CORE certification (health plan, vendor, clearinghouse and large provider), Test Suite provides objective, standardized method to conduct non-exhaustive testing for each Phase II rule.

Rules (new rules for Phase II)

Related to 270/271 Eligibility:

1. Data Content 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.

2. Infrastructure-related Rules

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.

Patient Identification Rules
Goal: Provides enhanced patient matching and better information on why a match did not occur in an eligibility request.


• Normalizing Patient Last Name


• Use of AAA Error Codes for Reporting Errors in Subscriber/Patient IDs & Names Error

Related to 276/277 Claims Status*:

CORE Phase II Claim 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.

CALLING ALL CORE PARTICIPANTS!
Now is the time to provide your input on the draft CORE Phase II rules.

Voting Process and Timeline

To join the more than 100 industry stakeholders collaborating on the development of CORE Phase II rules, click here to download a CORE Participant Application Form. For more information, please contact CAQH at (202) 861-1492.

* Enhancing/expanding upon Phase I rules