Phase IV CAQH CORE Operating Rules

VII. Resources for Implementing the Phase IV CAQH CORE Operating Rules

NOTE: Implementation of the Phase IV CAQH CORE Operating Rules is currently voluntary. HHS will determine if the Phase IV CAQH CORE Operating Rules will be included in any regulatory mandates. The Phase IV FAQs are for use by entities completing voluntary implementation of the operating rules and/or pursuing Phase IV CORE Certification which will be available in Fall 2016. 

 

  1. What resources are available to assist my organization with implementation of the Phase IV CAQH CORE Operating Rules?
  2. When will CORE Certification be offered for the Phase IV CAQH CORE Operating Rules?
1. What resources are available to assist my organization with implementation of the Phase IV CAQH CORE Operating Rules?

The CAQH CORE Implementation Resources webpage has a number of resources and tools available at no cost to assist entities with implementation of the Phase IV CAQH CORE Operating Rules including an Analysis & Planning Guide for Implementing the Phase IV CAQH CORE Operating Rules, frequent CAQH CORE Education Events, and more.

2. When will CORE Certification be offered for the Phase IV CAQH CORE Operating Rules?

Voluntary CORE Certification for the Phase IV CAQH CORE Operating Rules is now available. Phase IV CORE Certification covers four healthcare business transactions: healthcare claims; prior authorization; employee premium payment; and enrollment and disenrollment in a health plan. Entities interested in pursuing Phase IV CORE Certification should review the Phase IV CAQH CORE Voluntary Certification Test Suite which documents the test scripts required for Phase IV CORE Certification.