CORE Rules: HIPAA 5010 Updates

The CORE Phase I and Phase II policies and rules have been updated to reflect HIPAA 5010 requirements and associated errata. Please see below for each of the adjusted CORE rules. In addition to the updated rules, a summary of substantive changes made is available here: CORE Phase I and Phase II Rules 5010 Adjustment Summary

Phase I

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.

100: Guiding Principles

101: Pledge

• CORE Phase I Seal Application
• HIPAA Attestation Form

102: Certification Policy

103: Exemption Policy

• Health Plan IT Exemption Request Form

104: Testing Policy

105: Enforcement Policy

CORE Phase I Operating Rules (150-157)

• 150: Batch Acknowledgements
        View substantive v5010 edits as tracked changes


• 151: Real Time Acknowledgements
        View substantive v5010 edits as tracked changes


• 152: Companion Guide Rule
        View substantive v5010 edits as tracked changes


• CORE v5010 Master Companion Guide Template
        View substantive v5010 edits as tracked changes


• 153: Connectivity
        View substantive v5010 edits as tracked changes


• 154: Eligibility (270-271) Data Content Rule
        View substantive v5010 edits as tracked changes


• 155: Eligibility_Benefits Batch Response Time Rule
        View substantive v5010 edits as tracked changes


• 156: Eligibility_Benefits Real-Time Response Time Rule
        View substantive v5010 edits as tracked changes


• 157: System Availability
        View substantive v5010 edits as tracked changes


• Phase I: Certification Test Suite
        View substantive v5010 edits as tracked changes
• Phase I: Certification Test Bed Data

Phase II

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.

200: Guiding Principles

201: Pledge

• CORE Phase II Seal Application
• HIPAA Attestation Form

202: Certification Policy

203: Exemption Policy

• Health Plan IT Exemption Request Form

204: Testing Policy

205: Enforcement Policy

CORE Phase II Operating Rules (250, 258-260, 270)

• 250: Claim Status
        View substantive v5010 edits as tracked changes


• CORE v5010 Master Companion Guide Template
        View substantive v5010 edits as tracked changes


• 258: Normalizing Patient Last Name Rule
        View substantive v5010 edits as tracked changes


• 259: AAA Error Code Reporting Rule
        View substantive v5010 edits as tracked changes


• 260: Eligibility Data Content Rule
        View substantive v5010 edits as tracked changes


• 270: Connectivity Rule
        View substantive v5010 edits as tracked changes


• Phase II: Certification Test Suite
        View substantive v5010 edits as tracked changes
• Phase II: Certification Test Bed Data
• XML Schema Specification (normative)
• Web Services Definition Language (WSDL) Specification (normative)

For more information about the CORE Rules, CORE certification or applying for a CORE seal, please contact CAQH at (202) 861-1492.