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Operating Rules Development

Rule-Writing and Voting


CAQH CORE Voting Process*

Level 1: CAQH CORE Subgroups

Level 2: CAQH CORE Work Groups

Level 3: Full CAQH CORE Voting Membership

Level 4: CAQH CORE Board


CAQH CORE Operating Rules development starts at the Subgroup level. Beginning with thorough research and a sound business case, CAQH CORE Subgroups develop draft rule language/requirements. After extensive Subgroup vetting, including straw-polls, surveys and consensus agreement, the rules are referred up to the appropriate CAQH CORE Work Group for approval. Once approved via Work Group ballot, rules move forward to the Full CAQH CORE Voting Membership and then the CAQH CORE Board for review and approval.


  • The CAQH Board/CAQH does not have veto or voting power over the CAQH CORE Operating Rules.
  • Any entity that is a CAQH CORE Participant per the CAQH CORE application process has a right to vote on the rules, understanding that at Level 3 only entities that will implement the rules vote on the rules.


Role of CAQH CORE Subgroups


The role of CAQH CORE Subgroups is to develop draft rules for review by the Work Groups; build consensus and refine rules via discussion, surveys, and straw polls. There is no formal voting at the Subgroup level. Subgroups meet approximately every two weeks by conference call during rule writing, or periodically during other critical times.


Role of CAQH CORE Work Groups


The role of CAQH CORE Work Groups is to review and approve CAQH CORE Rules for ballot by the Full CAQH CORE Voting Membership. Work Groups meet monthly during rule writing, or periodically during other critical times. 
  • Rules Work Group: Writes the business rules related to transactions using required and non-required HIPAA standards, and industry neutral standards where appropriate. The Rules Work Group also reviews and approves many of the business-based CORE infrastructure-related rules (e.g., system availability) to be applied to transactions being addressed by CAQH CORE.
  • Technical Work Group: Develops technical specifications and technical rules. In addition to developing rules for its assigned issues/activities, the Technical Work Group responds to issues from the Rules Work Groups that require technical evaluation or recommendations.
CAQH Program: