CAQH CORE Phase II Rules

Phase II

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.

200: Guiding Principles

201: Pledge

202: Certification Policy

203: Exemption Policy

204: Testing Policy

205: Enforcement Policy

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

250: Claim Status Rule

258: Normalizing Patient Last Name Rule

259: AAA Error Code Reporting Rule

260: Eligibility Data Content Rule

270: Connectivity Rule

Phase II: Certification Test Suite

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.

CAQH Program: