Earlier this year the CAQH CORE Board unanimously approved a set of new and updated CAQH CORE Operating Rules to bring forward for federal mandate. On May 23^rd, 2022 the Board submitted a letter to NCVHS that formally requested review of the new and updated rules for federal adoption. The letter outlines the Board’s rationale for supporting the proposed ruleset.

The proposed set of new and updated CAQH CORE Operating Rules include:

• Updated: Federally Mandated Infrastructure Rules
• Eligibility & Benefits (270/271) Infrastructure Rule vEB.2.0
• Claim Status (276/277) Infrastructure Rule vCS.2.0
• Payment & Remittance (835) Infrastructure Rule vPR.2.0
• Updated: Connectivity Rule vC4.0.0
• Updated: Eligibility & Benefits (270/271) Data Content Rule vEB.2.0
• New: Eligibility & Benefits (270/271) Single Patient Attribution Data Content Rule vEB.1.0
• New: Attachments Operating Rules
• Attachments Prior Authorization Infrastructure Rule vPA.1.0
• Attachments Prior Authorization Data Content Rule vPA.1.0
• Attachments Health Care Claims Infrastructure Rule vHC.1.0
• Attachments Health Care Claims Data Content Rule vHC.1.0

NCVHS will review industry feedback on the proposed operating rules via comment letters and the industry hearing on January 18 and 19, 2023 to inform a recommendation to the Secretary of HHS on federal adoption. Please see the resources and tools below for more detail on the proposed operating rule requirements, updates from prior mandated versions, and benefits of adoption.

• CAQH CORE Board Letter to NCVHS: In its May 2022 letter requesting review of the proposed operating rules to NCVHS, the CORE Board outlines its rationale for supporting federal adoption and value of the new and updates rules.


• Proposed Operating Rules Cheat Sheet: This document provides a side-by-side comparison of requirements in the currently mandated operating rules with the proposed updated versions, outlines new rule requirements, and highlights the benefits of the proposed rules.


• CAQH CORE Connectivity Rule Comparison: This document specifically compares requirements in the federally mandated Phase I CORE 153: Eligibility and Benefits Connectivity Rule and Phase II CAQH CORE 270: Connectivity Rule to updates made in CAQH CORE Connectivity Rule vC4.0.0.
• NCHVS CAQH CORE Operating Rule Implementation Survey Tool: This document helps organizations understand the impact, costs, and benefits of implementing operating rules. This tool provides a high-level framework to gather estimates of the resources required for operating rule implementation, assess savings opportunities, and assign value scores across the advantages that rules could afford for your organization.


• NCVHS RFC Guidance Document: This document summarizes the questions posed by NCVHS in the RFC and provides guidance on how to approach responses including relevant operating rule information and impact.


• CAQH CORE Board Chairs’ Blog Post: Timothy Kaja, President, Networks & Network Support, Optum Health; Immediate Past Chair, CAQH CORE Board and Linda Reed, Senior Vice President and Chief Information Officer, St. Joseph’s Health; Chair, CAQH CORE Board share their thoughts on the value of the proposed rules.


• Relevant Past CAQH CORE Webinars
  • The Value of Standardization and Automation, a conversation with CAQH CORE Board Member Margaret Schuler – Slides PDF (11/03/22)
  • Eligibility & Benefits Standards and Operating Rules, a Joint webinar with CAQH CORE and X12 – Slides PDF (07/11//22)
  • New CAQH CORE Operating Rules – Slides PDF (04/27/22)
  • New CAQH CORE Operating Rules to Improve Patient Attribution Data Sharing and Connectivity – Slides PDF (02/16/21)