FAQ Categories

• Part A: ACA Section 1104 Mandate for Federal Operating Rules Expand Secondary Navigation Menu
  • 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
• Part B: CAQH CORE Connectivity Expand Secondary Navigation Menu
  • I. General Connectivity FAQs
  • II. CAQH CORE Connectivity Rule vC2.2.0
  • III. CAQH CORE Connectivity Rule vC3.1.0
  • IV. CAQH CORE Connectivity Rule vC4.0.0
  • V. CAQH CORE Connectivity Rule vC4.0.0 -- SOAP Requirements
  • VI. CAQH CORE Connectivity Rule vC4.0.0 -- REST Requirements
• Part C: CAQH CORE Eligibility & Benefits Operating Rules Expand Secondary Navigation Menu
  • I. General CAQH CORE Eligibility & Benefits Operating Rules Questions
  • II. CAQH CORE Eligibility & Benefits (270/271) Infrastructure Rule
  • II. Interdependent CAQH CORE Eligibility & Benefit Requirements
  • III. CAQH CORE 150: Batch Acknowledgements Rule
  • III. CAQH CORE Eligibility & Benefits (270/271) Data Content Rule
  • IV. CAQH CORE Eligibility & Benefits (270/271) Single Patient Attribution Data Rule
  • IX. CAQH CORE 156: Real Time Response Time Rule
  • V. CAQH CORE 152: Companion Guide Rule
  • VI. CAQH CORE 153: Connectivity Rule
  • VIII. CAQH CORE 155: Batch 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
  • XV. CAQH CORE 270: Connectivity Rule
  • XVI. Resources for Implementing the CAQH CORE Eligibility & Claim Status Operating Rules
• Part D: CAQH CORE Claim Status Operating Rules
• Part E: CAQH CORE Payment & Remittance Operating Rules Expand Secondary Navigation Menu
  • I. General CAQH CORE Payment & Remittance Operating Rules
  • II. CAQH CORE Payment & Remittance (835) Infrastructure Rule
  • III. CAQH CORE Payment & Remittance Uniform Use of CARCs and RARCs (835) Rule
  • IV. CAQH CORE Payment & Remittance Reassociation (CCD+/835) Rule
  • V. CAQH CORE Payment & Remittance EFT Enrollment Data Rule
  • VI. CAQH CORE Payment & Remittance ERA Enrollment Data Rule
  • VII. Resources for Implementing the CAQH CORE Payment & Remittance Operating Rules
• Part F: CAQH CORE Prior Authorization & Referrals Operating Rules Expand Secondary Navigation Menu
  • I. General CAQH CORE Prior Authorizations & Referrals Operating Rule Questions
  • II. CAQH CORE Prior Authorization & Referrals (278) Infrastructure Rule
  • III. CAQH CORE Prior Authorization & Referrals (278) Data Content Rule
  • IV. Web Portal CAQH CORE Prior Authorization & Referrals Web Portal Rule
  • V. General CAQH CORE Attachments Prior Authorization Operating Rule Questions
  • VI. CAQH CORE Attachments Prior Authorization Infrastructure Rule
  • VII. CAQH CORE Attachments Prior Authorization Data Content Rule
• Part G: CAQH CORE Health Care Claims Operating Rules Expand Secondary Navigation Menu
  • I. General CAQH CORE Health Care Claims Operating Rules Questions
  • II. CAQH CORE Health Care Claims (837) Infrastructure Rule
  • III. General CAQH CORE Attachments Claims Operating Rule Questions
  • IV. CAQH CORE Attachments Claims Infrastructure Rule Questions
  • V. CAQH CORE Attachments Claims Data Content Rule Questions
• Part H: CAQH CORE Benefit Enrollment Operating Rules Expand Secondary Navigation Menu
  • I. General CAQH CORE Benefit Enrollment Operating Rule Questions
  • II. Benefit Enrollment (834) Infrastructure Rule
• Part I: CAQH CORE Premium Payment Operating Rules Expand Secondary Navigation Menu
  • I. General CAQH CORE Premium Payment Operating Rule Questions
  • II. CAQH CORE Premium Payment (820) Infrastructure Rule
• Part J: Certification: CORE Certification, CORE Recertification, and CORE Endorsement Expand Secondary Navigation Menu
  • I. Background on ACA Section 1104 Certification
  • I. Introduction to CORE Certification Expand Secondary Navigation Menu
    • A. CORE Certification and Recertification: Overview Expand Secondary Navigation Menu
      • i. CORE Certification Overview
      • ii. CORE Recertification Overview
    • B. CORE Certification: Stakeholder Specific Questions Expand Secondary Navigation Menu
      • i. Stakeholder Specific Questions
      • ii. Questions Specific to Non-Health Plans
    • C. CORE Certification: Testing Expand Secondary Navigation Menu
      • i. CORE Certification Testing Overview
      • ii. Eligibility & Benefits CORE Certification Testing
      • iii. Claim Status CORE Certification Testing
      • iv. Payment & Remittance CORE Certification Testing
      • v. Prior Authorization & Referrals CORE Certification Testing
      • vi. Health Care Claims CORE Certification Testing
      • Vii. Benefit Enrollment CORE Certification Testing
      • viii. Premium Payment CORE Certification Testing
  • II. Introduction to CORE Endorsement
  • III. Introduction to Proposed CORE HIPAA Credential
  • III. Related Resources and Links