The Eligibility & Benefits Operating Rules establish consistent requirements for the exchange information regarding a patient’s insurance coverage and benefits between health plans and providers. A set of these rules are federally mandated—more information on all CAQH CORE federally mandated rules can be found here.
Complete Set of CAQH CORE Eligibility & Benefits Operating Rules
- CAQH CORE Connectivity: Visit the CAQH CORE Connectivity webpage for more information on which version of CAQH CORE Connectivity is required for implementation with these rules.
- CORE Certification/Endorsement: Learn more about CORE Certification and CORE Endorsement for the Eligibility & Benefits Operating Rules by visiting the CORE Certification webpage.
- Resource Library: Visit the Resource Library to access FAQs, Analysis & Planning Guides, the CAQH CORE Master Companion Guide webinars, and more to support implementation of the CAQH CORE Operating Rules.
For more information about the Operating Rules process or CORE Certification, contact CAQH CORE at CORE@caqh.org.