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)

CAQH CORE 300: Guiding Principles

CAQH CORE 301: Pledge

CAQH CORE 302: Certification Policy

CAQH CORE 303: Exemption Policy

CAQH CORE 304: Testing Policy

CAQH CORE 305: Enforcement Policy

Phase III CAQH CORE EFT & ERA Operating Rules

Phase III: Certification Test Suite Version
3.0.0

For more information about the operating rules process or Voluntary CORE Certification, contact CAQH CORE at CORE@caqh.org.

CAQH Program: