Operating Rules

CAQH CORE: Operating Rules to Drive the Business of Healthcare 

  • Established in 2005, CAQH CORE is a multi-stakeholder collaboration of more than 130 organizations –providers, health plans, vendors, government agencies, and standard-setting bodies – developing operating rules to simplify healthcare administrative transactions. CAQH CORE participating organizations include health plans representing more than 75% of commercially insured lives, plus Medicare and Medicaid beneficiaries.
  • Operating rules support a range of existing standards to make electronic data transactions more predictable and consistent, regardless of the technology. Operating rules facilitate many high-volume transactions that involve multiple parties, such as automated banking transactions and airline ticket bookings.
  • The CORE process centers on an integrated model consisting of: rule development, testing and certification, and measure tracking/outreach.
  • A voluntary CORE Certification program drives value and return on investment for all trading partners by ensuring the rules are used consistently; thereby encouraging broader use of the rules. Health plans, providers, vendor/clearinghouses that create, transmit or use administrative data may become CORE-certified. 
ACA Operating Rules Timeline
  Eligibility and Claim Status EFT & ERA Other Transactions
Adoption Deadline 7/1/2011 7/1/2012 7/1/2014
Effective Date 1/1/2013 1/1/2014 1/1/2016


CAQH Program: