CAQH CORE Phase I 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.

100: Guiding Principles

101: Pledge

102: Certification Policy

103: Exemption Policy

104: Testing Policy

105: Enforcement Policy

CORE Phase I Operating Rules (150-157)

150: Batch Acknowledgements Rule

151: Real Time Acknowledgements Rule

152: Companion Guide Rule

153: Connectivity Rule

154: Eligibility (270-271) Data Content Rule

155: Eligibility_Benefits Batch Response Time Rule

156: Eligibility_Benefits Real-Time Response Time Rule

157: System Availability 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.

CAQH Program: