The CAQH CORE Eligibility & Benefits (270/271) Operating Rules address the following:
Eligibility Rule |
Addresses |
High-Level CAQH CORE Key Requirements |
Data Content |
Need to drive further industry value in transaction processing
|
Respond to generic and explicit inquiries for a defined set of 175+ service type codes and 4 categories of services for procedure codes with:
|
Infrastructure |
Industry needs for common guidelines/accessible documentation |
|
Single Patient Attribution** |
Provider need for attribution information at point of service for value-based arrangements. |
|
*The HHS Final Rule excludes rule requirements pertaining to use of Acknowledgments.
**This rule was approved by CAQH CORE Participants in 2020 and is not federally mandated.
The CAQH CORE Eligibility & Benefits (270/271) Operating Rules also address standard testing, certification, and enforcement processes to ensure CAQH CORE conformance for entities seeking CORE Certification.