Frequently Asked Questions - CAQH CORE Connectivity Rule vC4.0.0

Does the CAQH CORE Connectivity Rule vC4.0.0 support all electronic healthcare transactions?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 13:49
Does the CAQH CORE Connectivity Rule vC4.0.0 support all electronic healthcare transactions?

The aim of the CAQH CORE Connectivity Rule Update is to create a single, uniform connectivity rule with requirements that support all electronic healthcare transactions.

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Is the CAQH CORE Connectivity Rule vC4.0.0 payload agnostic?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 13:50
Is the CAQH CORE Connectivity Rule vC4.0.0 payload agnostic?

Yes. The CAQH CORE Connectivity Rule vC4.0.0 is designed to be payload agnostic. The ACA-mandated CAQH CORE Connectivity Rule vC2.2.0 and voluntary CAQH CORE Connectivity Rule vC3.1.0 support the exchange of both HIPAA-mandated and non-HIPAA mandated transactions. The CAQH CORE Connectivity Rule vC4.0.0 take a similar approach as the prior connectivity rules by accommodating various payload types and providing generic and specific examples for both mandated and non-mandated transactions.

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Can an organization implement a standard that is a higher version than what is listed in Section 3.2 Standards Used in this Rule (e.g., TLS 1.3)?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 13:50
Can an organization implement a standard that is a higher version than what is listed in Section 3.2 Standards Used in this Rule (e.g., TLS 1.3)?

Yes. Organizations are not precluded from supporting versions higher than what is minimally specified in Section 3.2 Standards Used in this Rule (e.g., TLS 1.2 or higher).
 

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How were the transactions listed in the Section 3.3 When the Rule Applies chosen?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 13:51
How were the transactions listed in the Section 3.3 When the Rule Applies chosen?

To create a single, uniform CAQH CORE Connectivity Rule, Section 3.3 When this Rule Applies of CAQH CORE Connectivity Rule vC3.1.0 was updated to include all X12 transactions addressed by CAQH CORE Operating Rules, both published (mandated and voluntary) and in development.

 

Similar to the approach taken in CAQH CORE Connectivity Rule vC3.1.0, Section 3.3 references CAQH CORE Connectivity Rule vC2.2.0 to clarify that while the requirements in CAQH CORE Connectivity Rule vC4.0.0 support the specified X12 transactions, HIPAA-covered entities must continue to support the requirements established in the ACA-mandated CAQH CORE Connectivity Rule vC2.2.0.

 

Additionally, while the CAQH CORE Connectivity Rule vC4.0.0 specifies requirements for all X12 transactions addressed in CAQH CORE Operating Rules (i.e., those transactions listed in Section 3.3 When the Rule Applies), the connectivity and security requirements can optionally be applied to additional payload types (e.g., C-CDA, .pdf, .doc, etc.) as the connectivity specifications are payload agnostic.

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When will the industry be required to implement changes to CAQH CORE Safe Harbor Connectivity made in this version of the rules?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 13:51
When will the industry be required to implement changes to CAQH CORE Safe Harbor Connectivity made in this version of the rules?

Currently, CAQH CORE Connectivity Rule vC3.1.0, including the updated CAQH CORE Connectivity Rule vC4.0.0, are voluntary for industry adoption, while CAQH CORE Connectivity Rules vC1.1.0 and vC2.2.0 are ACA-mandated for adoption.

 

The CAQH CORE Board plans to propose the revised CAQH CORE Connectivity Rule vC4.0.0 to the National Committee on Vital and Health Statistics (NCVHS) for recommendation to the HHS Secretary for national adoption under HIPAA. Should the revised CAQH CORE Connectivity Rule vC4.0.0 become mandated in the future, there would be an implementation period for the industry to mitigate systems and business processes to meet the revised requirements.

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Do the requirements included in the CAQH CORE Connectivity Rule vC4.0.0 apply only to the transactions conducted by a particular entity?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 13:52
Do the requirements included in the CAQH CORE Connectivity Rule vC4.0.0 apply only to the transactions conducted by a particular entity?

Yes. Similar to the previous CAQH CORE Connectivity Rules, the requirements only apply to the transactions conducted by a specific entity. This means that if an entity does not support one of the listed transactions, they are not required to support the connectivity requirements for that particular transaction.

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Section 3.3 When the Rule Applies lists X12 v6020 275 and X12 v5010 278. Why does the section have differing versions for the 275 and 278 transactions?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 14:27
Section 3.3 When the Rule Applies lists X12 v6020 275 and X12 v5010 278. Why does the section have differing versions for the 275 and 278 transactions?

Since v5010X217 278 is currently specified in the CAQH CORE Prior Authorization Rules and is the HIPAA-mandated version, we recommend continued support for v5010 for consistency across existing CAQH CORE Operating Rules. Given there is no HIPAA-mandated standard for attachments, the X12 v6020 275 is specified in this rule because it is the standard that was recommended for adoption by X12 to the National Committee on Vital Health Statistics. Under Section 3.7 Rule Maintenance, maintenance to the rule is triggered when published Federal regulation or Federal notices to the industry impact the transactions, standards or technology addressed by this rule.

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When would a provider system act as both a client and a server and therefore need to comply with the requirements for both REST and SOAP exchanges rather than either REST or SOAP?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 14:28
When would a provider system act as both a client and a server and therefore need to comply with the requirements for both REST and SOAP exchanges rather than either REST or SOAP?

In the instance that a provider or provider vendor implements a server (e.g., message receiver), it must support both exchange methods specified by the CAQH CORE Connectivity Rule vC4.0.0 (SOAP and REST).

Please note, that providers and provider vendors most often act as a client (e.g., message sender), meaning they do not have a server implemented. When a provider or provider vendor does not have a server implemented, they are only required to implement one of the two CAQH CORE Connectivity Rule vC4.0.0 exchange methods – SOAP or REST.

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What exchange methods are supported by the CAQH CORE Connectivity Rule vC4.0.0 and what are the implementation requirements for my organization?

Submitted by kcooper@caqh.org on Fri, 02/18/2022 - 14:29
What exchange methods are supported by the CAQH CORE Connectivity Rule vC4.0.0 and what are the implementation requirements for my organization?

The CAQH CORE Connectivity Rule vC4.0.0 support the exchange of two connectivity methods, SOAP and REST. The CAQH CORE Connectivity Rule vC4.0.0 outlines requirements individually for each exchange method.

 

The CAQH CORE Connectivity Rule vC4.0.0 is a CAQH CORE Safe Harbor connectivity method meaning that:

  • Health Plans and Health Plan Vendors (servers) must implement capability to support both CAQH CORE Connectivity Rule vC4.0.0 SOAP and REST requirements.
  • Intermediaries, including Clearinghouses, Switches, and Health Information Exchanges that act as servers must implement the capability to support both CAQH CORE Connectivity Rule VC4.0.0 SOAP and REST requirements.

Providers and Provider Vendors (clients) must implement capability to support one of the two exchange methods, either CAQH CORE Connectivity Rule VC4.0.0 SOAP or REST requirements. If a Provider or a Provider Vendor implement a server, then it must implement capability to support both CAQH CORE Connectivity Rule vC4.0.0 SOAP and REST requirements.

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