Payment and Remittance Operating Rules

The CAQH CORE Payment & Remittance Operating Rule Set addresses a range of operating rule requirements for the HIPAA-mandated EFT and ERA transactions including streamlining provider enrollment, EFT and ERA reassociation, infrastructure, and consistent use of claim adjustment and denial codes.

Regulatory Status

On August 10, 2012, HHS issued an Interim Final Rule with Comment (IFC) adopting the complete CAQH CORE Payment & Remittance Operating Rules, including the CORE v5010 Master Companion Guide Template, to fulfill the ACA Section 1104 Federal mandate for national Payment & Remittance Operating Rules. Covered entities must be in compliance with the Payment & Remittance Operating Rule Set by January 1, 2014. In April 2013, CMS issued a notice adopting CMS-0028-IFC as a Final Rule. This notice also urged stakeholders to get involved in the CAQH CORE Code Combinations Maintenance Process.

Complete Set of CAQH CORE Payment & Remittance Operating Rules

CAQH CORE Payment & Remittance (835) Infrastructure Rule vPR.1.0

      • CAQH CORE v5010 Master Companion Guide

CAQH CORE Payment & Remittance Uniform Use of CARCs and RARCs (835) Rule vPR.1.0

CAQH CORE Payment & Remittance (CCD+/835) Reassociation Rule vPR.1.0

CAQH CORE Payment & Remittance EFT Enrollment Data Rule vPR.1.0

      •  Excel Copy of the CORE-required Maximum EFT Enrollment Data Set

CAQH CORE Payment & Remittance ERA Enrollment Data Rule vPR.1.0

      •  Excel Copy of the CORE-required Maximum ERA Enrollment Data Set

CAQH CORE Connectivity Rule vC2.2.0

        XML Schema v2.2.0

        WSDL Schema v2.2.0

CORE Certification & Endorsement

CORE Certification for Payment & Remittance is available to all entities that create, transmit or use payment and remittance transactions. Entities that do not use, create or transmit payment and remittance transactions can demonstrate their support for CAQH CORE’s mission and its operating rules through CORE Endorsement.

Implementation Resources 

Visit the Resource Library webpage to access FAQs, Analysis & Planning Guides, Webinars and more to support implementation of the CAQH CORE Operating Rules. For more information about the operating rules process or CORE Certification, contact CAQH CORE at CORE@caqh.org

CAQH Program