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Frequently Asked Questions
Implementation of the Phase I, II, and III CAQH CORE Operating Rules is mandated for all HIPAA-covered entities by the ACA (with the exception of requirements pertaining to acknowledgments). Implementation of the Phase IV CAQH CORE Operating Rules is currently voluntary. HHS will determine if the Phase IV CAQH CORE Operating Rules will be included in any regulatory mandates. CAQH CORE offers CORE Certification for Phases I, II, III and IV.
Please note: On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) launched a new Administrative Simplification website. CAQH CORE has updated the hyperlinks to CMS's new Administrative Simplification website referenced in the FAQs. We will continuously monitor the CMS website for any new changes and to ensure all hyperlinks on our site remain up-to-date.
CAQH CORE offers more than 700 Frequently Asked Questions (FAQs) addressing all four phases 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.
If you have any questions not addressed by the CAQH CORE Online Resources, please email CORE@caqh.org.
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: General CAQH CORE FAQs
General FAQs address CAQH CORE’s background and mission, the CAQH CORE Rules Development Process, and procedures and policies related to CORE Participation, CORE Certification, and CORE Endorsement.
part b: ACA Section 1104 Mandate for Federal Operating Rules
These FAQs address HHS adoption status of the ACA-mandated operating rules and related ACA Federal compliance requirements.
NOTE: The CMS National Standards Group (NSG) is the authority on the HIPAA and ACA Administrative Simplification provisions; more detailed information on the provisions, as well as compliance and enforcement requirements, is available on the CMS website and via the CMS FAQs.
part c: Phase I & II CAQH CORE Eligibility & Claim Status Operating Rules
These FAQs address technical rule requirements and stakeholder specific implementation for the first set of ACA-mandated operating rules. (CAQH CORE Phase I and II)
part d: Phase III CAQH CORE EFT & ERA Operating Rules
These FAQs address technical rule requirements and stakeholder specific implementation for the second set of ACA-mandated operating rules. (CAQH CORE Phase III)
part e: Phase IV CAQH CORE Operating Rules
Implementation of the Phase IV CAQH CORE Operating Rules is currently voluntary. HHS will determine if the Phase IV CAQH CORE Operating Rules will be included in any regulatory mandates. The Phase IV FAQs are for use by entities completing voluntary implementation of the operating rules and/or pursuing Phase IV CORE Certification.
These FAQs address technical rule requirements and stakeholder specific implementation for the Phase IV CAQH CORE Operating Rules.
part f: CAQH CORE Operating Rules in Development
These FAQs address both current CAQH CORE rules development to address the remaining ACA Section 1104 operating rules and drafted voluntary CAQH CORE Operating Rules in development.
part g: CORE certification & CORE endorsement
These FAQs address certification-related topics including CORE Certification policies, CORE Certification testing and CORE Endorsement.
I. Introduction to CORE Certification
A. CORE Certification: Overview & Policies
B. CORE Certification: Stakeholder Specific Questions
C. CORE Certification: Testing