The CAQH CORE FAQs are in the process of being updated. CAQH CORE appreciates your patience as these updates are made. Implementation of the CAQH CORE Operating Rules for Eligibility & Benefits, Claim Status and Payment & Remittance is mandated for all HIPAA-covered entities by the ACA (with the exception of requirements pertaining to acknowledgments). Implementation of the CAQH CORE Operating Rules for Prior Authorization & Referrals, Health Care Claims, Benefit Enrollment and Premium Payment is currently voluntary. HHS will determine whether the voluntary CAQH CORE Operating Rules will be included in any future regulatory mandates. CAQH CORE offers CORE Certification for all the CAQH CORE Operating Rules CAQH CORE has developed Frequently Asked Questions (FAQs) addressing all of the CAQH CORE Operating Rules, general CAQH CORE information, CORE Certification and future development of operating rules. You may find your FAQ by clicking on the links below or using the search bar above to identify key words. NOTE: The CAQH CORE FAQs are for informational purposes only; in the case of a discrepancy between this document and CAQH CORE Operating Rule text and/or Federal regulations, the latter take(s) precedence. No adjustments to CAQH CORE rule requirements will be made via the FAQ process. part a: ACA Section 1104 Mandate for Federal Operating Rules I. Overview: ACA Section 1104 Provisions for Federal Operating Rules II. Requirements for Federal Operating Rules Addressing the Eligibility & Benefits and Claim Status Transactions III. Requirements for Federal Operating Rules Addressing the Payment & Remittance Transactions part B: CAQH CORE Connectivity I. General Connectivity Operating Rules Questions II. CAQH CORE Connectivity Rule vC2.2.0 III. CAQH CORE Connectivity Rule vC3.1.0 IV. CAQH CORE Connectivity Rule vC4.0.0 CAQH CORE Connectivity Rule vC4.0.0 -- SOAP Requirements CAQH CORE Connectivity Rule vC4.0.0 -- REST Requirements part C: CAQH CORE Eligibility & Benefits Operating Rules I. General CAQH CORE Eligibility & Benefits Operating Rules Questions II. CAQH CORE Eligibility & Benefits (270/271) Infrastructure Rule III. CAQH CORE Eligibility & Benefits (270/271) Data Content Rule IV. CAQH CORE Eligibility & Benefits (270/271) Single Patient Attribution Data Rule part d: CAQH CORE Claim Status Operating Rules I. CAQH CORE Claim Status Infrastructure Rule part e: CAQH CORE Payment & Remittance Operating Rules I. General CAQH CORE Payment & Remittance Operating Rules Questions 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 I. General CAQH CORE Prior Authorization & Referrals Operating Rules Questions II. CAQH CORE Prior Authorization & Referrals (278) Infrastructure Rule III. CAQH CORE Prior Authorization & Referrals (278) Data Content Rule IV. CAQH CORE Prior Authorization & Referrals Web Portal Rule V. General CAQH CORE Attachments Prior Authorization Rule 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 I. General CAQH CORE Health Care Claims Operating Rules Questions II. CAQH CORE Health Care Claim (837) Infrastructure Rule III. General CAQH CORE Attachments Claims Infrastructure Rule Questions IV. CAQH CORE Attachments Claims Infrastructure Rule Questions V. CAQH CORE Attachments Health Care Claims Data Content Rule Questions Part h: CAQH CORE Benefit Enrollment Operating Rules I. General CAQH CORE Benefit Enrollment Operating Rule Questions II. CAQH CORE Benefit Enrollment (834) Infrastructure Rule Part i: CAQH CORE Premium Payment Operating Rules I. General CAQH CORE Premium Payment Operating Rule Questions II. CAQH CORE Premium Payment (820) Infrastructure Rule Part j: CAQH CORE Attributed Patient Roster Operating Rules FAQs pages are currently being updated. Thank you for your patience. Part k: Certification: CORE Certification, CORE Recertification, and CORE Endorsement I. Introduction to CORE Certification CORE Certification & Recertification: Overview CORE Certification Overview CORE Recertification Overview CORE Certification: Stakeholder Specific Questions Stakeholder Specific Questions CORE Certification: Testing CORE Certification Testing Overview Eligibility & Benefits CORE Certification Testing Claim Status CORE Certification Testing Payment & Remittance CORE Certification Testing Prior Authorization & Referrals CORE Certification Testing Health Care Claims CORE Certification Testing Benefit Enrollment CORE Certification Testing Premium Payment CORE Certification Testing II. Introduction to CORE Endorsement III. Related Resources and Links Type Article Audience Public CAQH Program CORE
