Frequently Asked Questions - I. General CAQH CORE Premium Payment Operating Rule Questions

Which entities should implement the CAQH CORE Premium Payment (820) Infrastructure Rule?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:05
Which entities should implement the CAQH CORE Premium Payment (820) Infrastructure Rule?

The CAQH CORE Premium Payment (820) Infrastructure Rule applies to all HIPAA covered entities that conduct the following transaction:

§   X12 v5010 820 Transaction

NOTE: This rule does not require any entity to conduct, use, or process the X12 v5010 820 transaction if it currently does not do so or is not required by Federal or state regulation to do so.  Entities acting in the role of a Business Associate of a HIPAA covered entity may also need to implement various aspects of the CAQH CORE Premium Payment (820) Infrastructure Rule. The HHS website provides charts to help organizations determine whether an organization or individual is a HIPAA covered entity. This rule optionally applies to other Non-X12 Additional Documentation payload types (e.g., HL7 C-CDA, .pdf, etc.) exchanged using the most recent CAQH CORE Connectivity Rule. Currently the CAQH CORE Premium Payment (820) Infrastructure Rule are voluntary and have not been adopted by HHS for mandatory adoption by HIPAA covered entities. HHS will determine if the CAQH CORE Premium Payment (820) Infrastructure Rule will be included in any regulatory mandates. While the CAQH CORE Premium Payment (820) Infrastructure Rule is currently voluntary, stakeholder entities are immediately eligible to implement the operating rules and to pursue CORE Certification.

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