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.