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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.
Phase I & II 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)
Phase III 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)
Phase IV CAQH CORE Operating Rules
Coming soon! In early 2016 a set of Phase IV CAQH CORE Operating Rules FAQs wil be published that addresses technical rule requirements and stakeholder specific implementation for these voluntary operating rules. Have an idea for an FAQ? Email it to firstname.lastname@example.org. Meanwhile, access the Phase IV Analysis and Planning Guide HERE.
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
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
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
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
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
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