Current Initiatives for CAQH CORE Participants

CAQH CORE Participating Organizations help ensure that operating rules continue to meet evolving business needs, by engaging in the rule development process and maintenance of existing operating rules. Work groups are open to all CAQH CORE Participating Organizations, and multiple individuals from the same Participating Organization may join. Because each organization has only one vote, participants collaborate with their colleagues to submit an organizational-level response during voting periods. 

Below is a list of CAQH CORE work groups that currently convene or are upcoming. In addition to contributing to these work groups and the formal CAQH CORE voting process, Participating Organizations benefit from exclusive education content and research opportunities. If you would like to join any of the following groups please contact core@caqh.org.  

Initiative

Focus

Current Objectives

Status

Rules Work Group

Rule Review

Reviews and ballots draft operating rules developed by the Subgroups prior to an All CAQH CORE Participant Vote.

Currently reviewing the Draft Phase V CAQH CORE Prior Authorization Operating Rules developed by the Prior Authorization Subgroup.

Active

Certification & Testing Subgroup

Test Suite Development

Develops the Certification Test Suites for draft operating rules.

Currently developing the test suite for the Draft Phase V CAQH CORE Prior Authorization Operating Rules.

Active

Technical Work Group

Test Suite / Technical Specification Review

Reviews and ballots draft technical operating rules and test suites developed by the Subgroups prior to an All CAQH CORE Participant Vote.

Upcoming

CORE Code Combinations Task Group Rule Maintenance Maintains the CORE Code Combinations in the Phase III CAQH CORE Uniform Use of CARCs and RARCs Rule. Active
Enrollment Data Task Group Rule Maintenance Maintains the CORE-required Maximum EFT & ERA Enrollment Data Sets in the Phase III CAQH CORE EFT & ERA Enrollment Data Rules. Upcoming
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