The Phase I and Phase II CAQH CORE Eligibility 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 and Claim Status Operating Rules address the following:
The Phase I and Phase II CAQH CORE Rules also address standard testing, certification, and enforcement processes to ensure CAQH CORE conformance for entities seeking CORE Certification.