Frequently Asked Questions

CAQH CORE has updated its operating rule structure. The CAQH CORE FAQs are in the process of being updated to align with the new structure. 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: General CAQH CORE FAQs

part b: ACA Section 1104 Mandate for Federal Operating Rules

part c: CAQH CORE Eligibility & Benefits and Claim Status Operating Rules

I. Overview of CAQH CORE Eligibility & Claim Status Operating Rules

II. Interdependent CAQH CORE Eligibility & Claim Status Requirements

III. CAQH CORE 150: Batch Acknowledgements Rule

IV. CAQH CORE 151: Real Time Acknowledgements Rule

V. CAQH CORE 152: Companion Guide Rule

VI. CAQH CORE 153: Connectivity Rule

VII. CAQH CORE 154: Eligibility & Benefits 270/271 Data Content Rule

VIII. CAQH CORE 155: Batch Response Time Rule

IX. CAQH CORE 156: Real Time Response Time Rule

X. CAQH CORE 157: System Availability Rule

XI. CAQH CORE 250: Claim Status Infrastructure Rule

XII. CAQH CORE 258: Normalizing Patient Last Name Rule

XIII. CAQH CORE 259: AAA Error Code Reporting Rule

XIV. CAQH CORE 260: Eligibility & Benefits Data Content (270/271) Rule

XV. CAQH CORE 270: Connectivity Rule

XVI. Resources for Implementing the CAQH CORE Eligibility & Claim Status Operating Rules

part d: CAQH CORE Payment & Remittance Operating Rules

part e: Phase IV CAQH CORE Operating Rules

part f: Phase V CAQH CORE Operating Rules

Part G: CAQH CORE Operating Rules in Development

Part H: Certification: ACA Section 1104 Certification, CORE Certification, Proposed CORE HIPAA Credential, and CORE Endorsement

I. Background on ACA Section 1104 Certification

II. Introduction to CORE Certification

III. Introduction to Proposed CORE HIPAA Credential

IV. Introduction to CORE Endorsement

V. Related Resources and Links

Type
Audience
CAQH Program