The CAQH CORE Eligibility & Benefits and Claim Status Operating Rules streamline the way eligibility/benefits and claim status healthcare administrative information is exchanged electronically. Easier, more reliable access to this information at the point of care can reduce the amount of time providers spend on administration by improving the accuracy of claims submitted, providing enhanced information on patient financial responsibility, and checking the status of a patient claim electronically.
The ACA-mandated CAQH CORE Eligibility & Benefits and Claim Status Operating Rules address the following:
|Type of Rule||Address||high-level caqh core key requirements|
|data content: eligibility & benefits||Need to drive further industry value in transaction processing||
Respond to generic and explicit inquiries for a defined set of 50+ high volums services with:
|infrastructure: eligibility & benefits and claim status||Industry needs for common/ accessible documentation||
*NOTE: The HHS Final Rule excludes rule requirements pertaining to use of acknowledgements