Frequently Asked Questions - III. General CAQH CORE Attachments Claims Operating Rule Questions

How will compliance regarding Attachments Claims Operating Rules be enforced?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 12:15
How will compliance regarding Attachments Claims Operating Rules be enforced?

In 2022, the Attachments Claims Operating Rules were published to industry for voluntary adoption. If an organization decides to pursue voluntary CORE Certification on the CAQH CORE Attachments Operating Rules, they have a maximum timeframe of 180 days to complete certification testing on the rule requirement after submission of the CAQH CORE Pledge to adopt the rule. CORE-certified entities are then required to recertify every three years. Non-conformance could impact an entity’s CORE Certification status.

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Why was the X12 v6020 275 chosen instead of other options, such as v5010 or v7030?
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Why was the X12 v5010 chosen for Claims Transactions when the rule supports v6020 of the Attachments transaction?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 12:51
Why was the X12 v5010 chosen for Claims Transactions when the rule supports v6020 of the Attachments transaction?

Since v5010X217 278 is currently specified in the CAQH CORE Prior Authorization Operating Rules and is the HIPAA-mandated version, the Attachments Subgroup – Prior Authorization Use Case voted, using a consensus-driven approach including straw polls, feedback forms, and discussions, to support X12 v5010 278 for consistency across existing CAQH CORE Operating Rules. Similarly, the Attachments Subgroup – Claims Use Case supported using X12 v5010 837 for consistency and parity across attachments rule sets and to align with the existing CAQH CORE Health Care Claims Infrastructure Rule which specifics X12 v5010 837.

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Is the X12 275 TR3 be available for Industry use?
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Will the CAQH CORE Attachments Claims Infrastructure Rule require providers to use the X12 275 transaction to send attachments to support a claim submission?
Are providers required to send an unsolicited X12 275 transaction when sending the original X12 837 claim submission?