- About CAQH CORE
- Operating Rules
- New Operating Rule Structure
- Eligibility & Benefits
- Claim Status
- Payment & Remittance
- Prior Authorization & Referrals
- Health Care Claims
- Benefit Enrollment
- Premium Payment
- Mandated Operating Rules
- CORE Certification
- Priority Topics
- Join CAQH CORE
- Resource Library
- CAQH ProView
- CAQH ProView for Groups
- CAQH ProView - Dental
- Provider Directory - DirectAssure
- Credentialing Solutions Suite
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CAQH CORE Participant Calendar
CAQH CORE Payment & Remittance Operating Rules
VIII. Resources for Implementing the CAQH CORE EFT & ERA Operating Rules
1. CAQH CORE Resources to Assist with Implementation of the Phase III CAQH CORE EFT & ERA Operating Rules
CAQH CORE has a number of resources and tools available at no cost to assist entities with implementing the Phase III CAQH CORE EFT & ERA Operating Rules.
- On the CAQH website:
- Federally Mandated Operating Rules Timeline with Associated Resources provides an overview of CAQH CORE activities related to the ACA Section 1104 mandated operating rules
- CAQH CORE EFT & ERA webpage provides an overview of CAQH CORE activities specific to the ACA-mandated second set
- The Sample Provider EFT Reassociation Data Request Letter contains instructions and a letter template that a provider receiving EFT payments may customize and email to its banks or use as talking points for a phone or in person meeting with its bank contacts to request delivery of the ACH Payment Related Information via a secure, electronic means. The ACH Payment Related Information contains the necessary data to reassociate EFTs and ERAs and is not automatically delivered to providers unless requested by the provider.
- The CAQH CORE Analysis & Planning Guide for Implementing the CAQH CORE EFT & ERA Operating Rules assists entities in determining which CAQH CORE rule requirements are applicable to their organization. This Analysis & Planning Guide helps organizations to identify which CAQH CORE Rule requirements may be outsourced to a Business Associate or vendor, and the system and/or process remediation necessary to ensure conformance with the CAQH CORE Rules. The Analysis & Planning Guide includes three tools:
- CAQH CORE Stakeholder & Business Type Evaluation to determine your organization’s stakeholder type(s) and understand the role of your vendors, intermediaries, or Business Associates in conducting the EFT and/or ERA transactions
- CAQH CORE Systems Inventory & Impact Assessment Worksheet to assess your organization’s external and internal systems that conduct EFT and/or ERA transactions and are impacted by the CAQH CORE Operating Rules
- CAQH CORE Gap Analysis Worksheet to determine the level of system and/or process remediation necessary for your organization to adopt the business and technical requirements of the CAQH CORE Operating Rules
- CAQH CORE holds frequent education sessions with various industry partners on implementation of the CAQH CORE Operating Rules. Information on upcoming sessions and materials (both slides & audio) from past sessions is available on the CAQH website. CAQH CORE also holds free monthly industry-wide Town Hall calls to update the industry on CAQH CORE activities.
- CORE Certification offers a useful resource for entities to ensure successful implementation of applicable CAQH CORE EFT & ERA Rule requirements. CORE Certification has been embraced by many entities given its value in assisting with CAQH CORE Operating Rule implementation and ensuring the greatest ROI is achieved with trading partners. CORE Certification testing with a CAQH CORE-authorized testing vendor is available online at no cost to entities.
- For each phase of CAQH CORE Operating Rules, a CORE Certification Master Test Suite is developed that outlines all of the requirements for entities seeking CORE Certification on the various phases of CAQH CORE Operating Rules. The Phase III CORE EFT & ERA Operating Rules Certification Master Test Suite includes information about key concepts, such as the role of trading partners, which apply beyond CORE Certification to general implementation of the CAQH CORE EFT & ERA Operating Rules.
2. Additional Resources to Assist with Implementation of the Phase III CAQH CORE EFT & ERA Operating Rules
- CMS Administrative Simplification/Affordable Care Act FAQs (FAQs are also available on a wide range of other topics)
- CARCs/RARCs Resources: Claim Adjustment Reason Codes List and related FAQs and Remittance Advice Remark Codes List and related FAQs (Washington Publishing Company)
- ASC X12 Interpretation Portal Information related to the meaning, use, and interpretation of ASC X12 Standards, Guidelines, and Technical Reports, including implementation guideline for the ASC X12N v5010 835 can be obtained from ASC X12.
- NACHA Operating Rules, which include requirements around Health Care Payments via ACH
- Any questions related to the NACHA Operating Rules can be directed to Priscilla Holland at email@example.com