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CAQH CORE Phase III Rules
The Complete Set of Phase III CAQH CORE EFT & ERA Operating Rules, developed by CORE Participants with industry input, was approved in the final CORE vote in June 2012 as the final step in the CORE voting process. On August 10,2012, HHS issued an Interim Final Rule with Comment (IFC) adopting the complete Phase III CAQH CORE EFT & ERA Operating Rules, including the CORE v5010 Master Companion Guide Template, to fulfill the ACA Section 1104 Federal mandate for national EFT & ERA Operating Rules. Covered entities must be in compliance with the EFT & ERA Operating Rule Set by January 1, 2014. In April 2013, CMS issued a notice adopting CMS-0028-IFC as a Final Rule. This notice also urged stakeholders to get involved in the CAQH CORE Code Combinations Maintenance Process. Phase III CORE Certification is voluntary.
NOTE: The Final Rule does not adopt the Batch Acknowledgement Requirements in Section 4.2 of CAQH CORE Rule 350, as the Secretary has not yet adopted HIPAA-standards for acknowledgements.
Phase III CAQH CORE Policies (300-305)
Phase III CAQH CORE EFT & ERA Operating Rules
- CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rule
- CORE-required Code Combinations for CORE-defined Business Scenarios for CAQH CORE 360 Rule
- For more information about the CAQH CORE Code Combinations Maintenance Process, please visit the Ongoing Maintenance of the CORE Code Combinations for CAQH CORE 360 Rule Webpage.
- CAQH CORE 370: EFT & ERA Reassociation (CCD+/835) Rule
- CAQH CORE 380: EFT Enrollment Data Rule
- CAQH CORE 382: ERA Enrollment Data Rule
- For more information about the CAQH CORE Enrollment Data Sets Maintenance Process, please visit the Enrollment Data Sets Maintenance Process for CAQH CORE 380 & 382 Rules Webpage.
Phase III: Certification Test Suite Version
For more information about the operating rules process or Voluntary CORE Certification, contact CAQH CORE at CORE@caqh.org.