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
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
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
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
Part i: CAQH CORE Premium Payment Operating Rules
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: 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
