CAQH CORE launched a Task Group in 2021 to evaluate opportunity areas for Operating Rule enhancement for the Electronic Delivery of Patient Financial and Benefit Information Rule. For ease of Rule reference, all updated and new rule requirements are highlighted in grey.
Which CAQH CORE Eligibility & Benefit Operating Rules are federally mandated?
All HIPAA-covered entities are required by Federal law to adopt the CAQH CORE Eligibility & Benefits (270/271) Operating Rules by January 1, 2013 for the X12 270/271 eligibility transaction. This includes the CAQH CORE Eligibility & Benefits (270/271) Infrastructure Rule and the CAQH CORE Eligibility & Benefits (270/271) Data Content Rule. For more information on the mandate click HERE. The CAQH CORE Eligibility & Benefits (270/271) Single Patient Attribution Data Rule, which enables provider notification of an attributed patient under a value-based care contract within the eligibility workflow, is not federally mandated.