Frequently Asked Questions

General CAQH CORE FAQs

General FAQs address CAQH CORE’s background and mission, the CAQH CORE Rules Development Process, and procedures and policies related to CORE Participation, CORE Certification, and CORE Endorsement.

ACA Section 1104 Mandate for Federal Operating Rules

These FAQs address HHS adoption status of the ACA-mandated operating rules and related ACA Federal compliance requirements.

NOTE: The CMS Office of E-Health Standards & Services (OESS) is the authority on the HIPAA and ACA Administrative Simplification provisions; more detailed information on the provisions, as well as compliance and enforcement requirements, is available on the CMS website and via the CMS FAQs.

CAQH CORE Eligibility & Claim Status Operating Rules

These FAQs address technical rule requirements and stakeholder specific implementation for the first set of ACA-mandated operating rules. (CAQH CORE Phase I and II)

CAQH CORE EFT & ERA Operating Rules

These FAQs address technical rule requirements and stakeholder specific implementation for the second set of ACA-mandated operating rules. (CAQH CORE Phase III)

CAQH CORE Operating Rules in Development

These FAQs address both current CAQH CORE rules development to address the remaining ACA Section 1104 operating rules and drafted voluntary CAQH CORE Operating Rules in development.

Certification: ACA Section 1104 Certification, CORE Certification, Proposed CORE HIPAA Credential, and CORE Endorsement

These FAQs address Certification-related topics including the requirements of ACA Section 1104 Certification, the proposed options to certify compliance including CORE Certification, the Proposed CORE HIPAA Credential and CORE Endorsement.

 

The FAQs will be updated as appropriate and to share lessons learned. 

NOTE: No adjustments to CAQH CORE rule requirements will be made via the FAQ process.

Additional CAQH CORE resources are available to assist with implementation of the ACA-mandated CAQH CORE Eligibility & Claim Status Operating Rules and CAQH CORE EFT & ERA Operating Rules:  See Operating Rules Mandate – Eligibility and Claims Status and Operating Rules Mandate – EFT & ERA.

If you have any additional questions not addressed by the CAQH CORE Online Resources, please email CORE@caqh.org.

  

Outline of CAQH CORE FAQs Table of Contents

FAQs Part A: General CAQH CORE 

I. Overview of CAQH CORE

II. Introduction to CORE Participation

III. Introduction to CORE Endorsement and CORE Certification

IV. CAQH CORE Measures of Success

V. CAQH CORE Resources and Links

FAQs Part B: ACA Section 1104 Federal Mandate 

I. Overview: ACA Section 1104 Provisions for Federal Operating Rules

II. Requirements for Federal Operating Rules Addressing the Eligibility & Claim Status Transactions

III. Requirements for Federal Operating Rules Addressing the EFT & ERA Transactions

FAQs Part C: CAQH CORE Eligibility & Claim Status Operating Rules 

I. Overview of CAQH CORE Eligibility & Claim Status Operating Rules

II. Interdependent CAQH CORE Eligibility & Claim Status Requirements

III. CAQH CORE 150: Batch Acknowledgements Rule

IV. CAQH CORE 151: Real Time Acknowledgements Rule

V. CAQH CORE 152: Companion Guide Rule

VI. CAQH CORE 153: Connectivity Rule

VII. CAQH CORE 154: 270/271 Data Content Rule

VIII. CAQH CORE 155: Batch Response Time Rule

IX. CAQH CORE 156: Real Time Response Time Rule

X. CAQH CORE 157: System Availability Rule

XI. CAQH CORE 250: Claim Status Infrastructure Rule

XII. CAQH CORE 258: Normalizing Patient Last Name Rule

XIII. CAQH CORE 259: AAA Error Code Reporting Rule

XIV. CAQH CORE 260: Data Content (270/271) Rule

XV. CAQH CORE 270: Connectivity Rule

XVI. Resources for Implementing the CAQH CORE Eligibility & Claim Status Operating Rules

XVII. Voluntary Phase I & Phase II CORE Certification

FAQs Part D: CAQH CORE EFT & ERA Operating Rules 

I. Overview of CAQH CORE EFT & ERA Operating Rules

II. Interdependent CAQH CORE EFT & ERA Requirements

III. CAQH CORE 350: Health Care Claim Payment/Advice (835) Infrastructure Rule

IV. CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rule

V. CAQH CORE 370: EFT & ERA Reassociation (CCD+/835) Rule

VI. CAQH CORE 380: EFT Enrollment Data Rule

VII. CAQH CORE 382: ERA Enrollment Data Rule

VIII. Resources for Implementing the CAQH CORE EFT & ERA Operating Rules

IX. Voluntary Phase III CORE Certification

FAQs Part E: CAQH CORE Operating Rules in Development 

I. Development of Remaining ACA-mandated Operating Rules

II. Development of Voluntary Operating Rules

FAQs Part F: ACA Section 1104 Certification, CORE Certification, Proposed CORE HIPAA Credential, and CORE Endorsement 

I. Background on ACA Section 1104 Certification

II. Introduction to CORE Certification

     A. CORE Certification: Overview & Policies

          i. CORE Certification: Overview

          ii. CORE Certification: Policies

     B. CORE Certification: Stakeholder Specific Questions

          i. Questions Specific to Health Plans

          ii. Questions Specific to Non-Health Plans

     C. CORE Certification: Testing

          i. CORE Certification Testing Overview

          ii. Phase I CORE Certification Testing

          iii. Phase II CORE Certification Testing

          iv. Phase III CORE Certification Testing

III. Introduction to Proposed CORE HIPAA Credential

IV. Introduction to CORE Endorsement

V. Related Resources and Links

Audience: 
CAQH Program: