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

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.

X12 v6020 275 was chosen as it is the version supported by X12 and the industry to be used to support the exchange of attachments.

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.

Yes. The X12 275 TR3 is available on Glass.

No. Providers are not required to use non-HIPAA mandated transactions, including the X12 v6020X314 275 transaction, to send an attachment or additional documentation. If providers do choose to use X12 275 to send an attachment, they should follow the relevant operating rule requirements.

No. Providers are not required to send an unsolicited X12 275 to support an X12 837 claim submission. The requirements only apply in instances when the provider sends an unsolicited X12 275, but they are not required to do so.