Phase I & II CAQH CORE Eligibility & Claim Status Operating Rules

III. CAQH CORE 150: Batch Acknowledgements Rule

1. Currently my organization’s EDI system only returns an ASC X12 Implementation Acknowledgement (999). If the functional group is rejected, must my system be changed to comply with the CAQH CORE 150: Batch Acknowledgement Rule?

Yes. The CAQH CORE 150: Batch Acknowledgements Rule Version 1.1.0 requires that the health plan or information receiver must always return an ASC X12 Implementation Acknowledgement (999) for all functional groups, whether or not the group is rejected. This requirement allows the provider to know within a reasonable timeframe if the submitted batch of inquiries was accepted by the health plan and will be processed. Likewise, the rule also requires that the provider must always return an ASC X12 Implementation Acknowledgement (999) Functional Acknowledgement for all functional groups whether or not the group is rejected, thereby allowing timely resolution of any issues.

2. My organization’s EDI system was developed in-house and does not currently support the TA1. However, our system does support the ASC X 12 Implementation Acknowledgements (999) for rejected functional groups. Is this okay under the CAQH CORE 150: Batch Acknowledgement Rule?

Yes. The CAQH CORE 150: Batch Acknowledgements Rule Version 1.1.0, addresses only the ASC X12 Implementation Acknowledgement (999); therefore your organization’s system must be able to return an ASC X12 Implementation Acknowledgement (999) for all functional groups. If it is unable to do so, your organization will need to remediate the system to be in conformance with the CAQH CORE Rule in order to become CORE-certified.

3. If my organization’s system is not changed to return the ASC X12 Implementation Acknowledgement (999), can my organization become CORE-certified?

Your organization must successfully complete all of the required certification test scripts required by the Phase I CAQH CORE Certification Test Suite to become CORE-certified. The test scripts for the CAQH CORE 150: Batch Acknowledgements Rule Version 1.1.0 will test for your system’s capabilities to return the ASC X12 Implementation Acknowledgement (999).

4. The TA1 Interchange Acknowledgment is described in the HIPAA Implementation Guide Appendix B: EDI Control Director. Do the CAQH CORE Operating Rules require its use?

No. The CAQH CORE Batch and Real Time Acknowledgement Rules do not address the use of the ASC X12 Interchange Acknowledgement TA1.