Frequently Asked Questions - II. CAQH CORE Premium Payment (820) Infrastructure Rule

  1. What was included in the April 2022 CAQH CORE Infrastructure update and how does it impact the CAQH CORE Premium Payment (820) Infrastructure Rule?
  2. How does an entity determine which version of CAQH CORE Connectivity to use when implementing the CAQH CORE Premium Payment (820) Infrastructure Rule?
  3. We are a health plan. Why would we consider implementing the client requirement for retrieving premium payment data from the source of the payment?
  4. What are the CAQH CORE Premium Payment (820) Infrastructure Rule requirements for entities to support real time and/or batch processing?
  5. Do the rules have requirements for a health plan that retrieves or pulls the X12 v5010 820 from another entity that is acting as a server?
  6. Why does this “Elapsed Time for Enrollment System Processing of Received Premium Payment Data” requirement exist?
  7. What my entity transmits or receives premium payment information is in something other than an X12 v5010 820 (ex. Excel spreadsheet, an XML document, a proprietary flat file, etc.) do the CAQH CORE Premium Payment (820) Infrastructure Rule still apply?
  8. Can a clearinghouse or vendor act on behalf of a health plan for providing X12 v5010 820 transaction Acknowledgments?
  9. The TA1 Interchange Acknowledgment is described in the HIPAA Implementation Guide Appendix B: EDI Control Director. Does the CAQH CORE Premium Payment (820) Infrastructure Rule require its use?
  10. Do the time frames for the CAQH CORE Premium Payment (820) Infrastructure Rule still apply if it is an especially large batch? Do the CAQH CORE Operating Rules define the batch size?
  11. Are there any requirements in the CAQH CORE Premium Payment (820) Infrastructure Rule regarding how often X12 v5010X218 Payroll Deducted and Other Group Premium Payment for Insurance Products (820) transaction should be submitted? (e.g., Do CAQH CORE
  12. Is an Acknowledgement necessary if the user sends premium payment data in a proprietary (not an X12 820) format in a real time mode?
  13. Are all CAQH CORE Premium Payment (820) Infrastructure Rule requirements with regard to Acknowledgement only applicable to scenarios where my organization receives data in an X12 v5010 820 format?
  14. My organization’s EDI system was developed in-house and does not currently support the TA1. However, our system does support the X12 v5010 999 Acknowledgment for rejected Functional Groups. Is this conformant under the CAQH CORE Premium Payment (820)
  15. Do the CAQH CORE Premium Payment (820) Infrastructure Rule Real Time Acknowledgement Requirements require that my organization’s system must always return an X12 v5010 999 Acknowledgment for the X12 v5010 820?
  16. Currently my organization’s EDI system only returns a positive X12 v5010 999 Acknowledgment reporting acceptance of the X12 v5010 820 that is submitted in Real Time Processing Mode. If the Functional Group is rejected, must my system be changed to com
  17. If an X12 v5010 820 is received in a batch, does the X12 v5010 999 Acknowledgment have to be returned in a batch?
  18. Does my organization have to send back an X12 v5010 999 Acknowledgment response if my system is down?
  19. Will there be a difference in system availability requirements for Batch versus Real Time Processing Modes?
  20. Why did the CAQH CORE Participants increase the weekly system availability requirement from 86% to 90% system availability for the CAQH CORE X Infrastructure Rule in 2022?
  21. Is the additional 24-hour downtime available per calendar quarter required to be taken in one 24-hour period?
  22. Is the additional 24-hour downtime per calendar quarter in addition to the weekly allocated downtime?
  23. Does the new quarterly system availability downtime requirement define calendar quarter?
  24. My organization includes system availability schedules in our Companion Guide. Does this satisfy the CAQH CORE Premium Payment (820) Infrastructure Rule requirements for system availability reporting?
  25. Why was the CAQH CORE Master Companion Guide Template updated?
  26. Why was the Master Companion Guide Template created for entities processing premium payments?
  27. Does the CAQH CORE Premium Payment (820) Infrastructure Rule require HIPAA-covered entities to publish a Companion Guide if they do not currently do so?
  28. Can I combine multiple Transaction Sets in a single companion guide?
What was included in the April 2022 CAQH CORE Infrastructure update and how does it impact the CAQH CORE Premium Payment (820) Infrastructure Rule?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:05
What was included in the April 2022 CAQH CORE Infrastructure update and how does it impact the CAQH CORE Premium Payment (820) Infrastructure Rule?

§  Substantive Update to System Availability Requirements. The weekly system availability requirement was updated across the CAQH CORE Infrastructure Rules including CAQH CORE Premium Payment (820) Infrastructure Rule from 86% per calendar week to requiring systems to be available 90% per calendar week.  Additionally, a new quarterly system availability requirement was added allowing systems 24 additional downtime hours per calendar quarter, in excess of the allowable weekly system downtime or 17 hours (10% system downtime per calendar week).

§  Non-Substantive Update to CAQH CORE Connectivity. Per CAQH CORE Certification Policy, CORE-certified entities are required to comply with the most recent published version of the CAQH CORE Connectivity Rule within two years of publication. Therefore, by January 1, 2023, CAQH CORE Connectivity vC4.0.0 will be required for all CAQH CORE Infrastructure Operating Rules. To align the rule requirements with this policy, the connectivity requirement language in the CAQH CORE Premium Payment (820) Infrastructure Rule was updated to require “most recent published and CAQH CORE adopted version of the CAQH CORE Connectivity Rule.

§  Non-Substantive Update to CAQH CORE Master Companion Guide Template. Past versions of the CAQH CORE Master Companion Guide referenced a specific version of the ASC X12N Implementation Guides, e.g., v5010. [EW1] However, with the creation of new operating rules such as CAQH CORE Attachments Operating Rules which use a different X12 version, not all operating rules use the same X12 version. To align with the need to address multiple X12 versions and enable greater flexibility, references to a specific X12 version were adjusted to be modifiable in the CAQH CORE Master Companion Guide.


 [EW1]Made this generic since the original companion guide templates actually referenced v4010.

Back to Top
How does an entity determine which version of CAQH CORE Connectivity to use when implementing the CAQH CORE Premium Payment (820) Infrastructure Rule?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:06
How does an entity determine which version of CAQH CORE Connectivity to use when implementing the CAQH CORE Premium Payment (820) Infrastructure Rule?

All CAQH CORE Infrastructure Operating Rules including CAQH CORE Premium Payment (820) Infrastructure Rule most recent published and CAQH CORE adopted version of the CAQH CORE Connectivity Rule” (please see the CAQH CORE Connectivity webpage for more information).  

Per CORE Certification Policy, entities seeking CORE Certification are required at a minimum to implement the version of CORE Connectivity published two years prior from when pursuing certification testing. Optionally, entities can choose to implement any newer versions of CORE Connectivity published within the past two years and attain certification depending on testing availability.

Back to Top
We are a health plan. Why would we consider implementing the client requirement for retrieving premium payment data from the source of the payment?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:06
We are a health plan. Why would we consider implementing the client requirement for retrieving premium payment data from the source of the payment?

As stated in the CAQH CORE Premium Payment (820) Infrastructure Rule, Section 4.1, Payroll Deducted and Other Group Premium Payment for Insurance Products Processing Mode Requirements, a HIPAA-covered health plan is not required to implement the client requirements, but “may also elect to implement the client requirements as specified in the CAQH CORE Connectivity Rule in addition to implementing the server requirements. When a HIPAA-covered health plan or its agent elects to implement the client requirements as specified in the CAQH CORE Connectivity Rule v4.0.0 it must comply with all requirements specified in Sections 4.2, 4.3, 4.4, 4.5, 4.6, 5 and all respective Subsections.”

A health plan may wish to implement the client requirements for the conduct of the 820 transactions due to a variety of reasons. One example may include managed care entities with which the health plan has partnered and therefore may conduct a pull (or fetch) of the 820 transactions from the health plan rather than the health plan pushing the transaction out to these entities.

Back to Top
What are the CAQH CORE Premium Payment (820) Infrastructure Rule requirements for entities to support real time and/or batch processing?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:07
What are the CAQH CORE Premium Payment (820) Infrastructure Rule requirements for entities to support real time and/or batch processing?

The CAQH CORE Premium Payment (820) Infrastructure Rule requires that a HIPAA-covered health plan or its agent must implement the server requirements for Batch Processing Mode for the X12 v5010 820 transaction as specified in the CAQH CORE Connectivity Rule. Optionally, a HIPAA-covered health plan or its agent may elect to also implement the server requirements for Real Time Processing Modes for the X12 v5010 820 transaction as specified in the CAQH CORE Connectivity Rule.

A HIPAA-covered health plan or its agent may also elect to implement the client requirements as specified in the CAQH CORE Connectivity Rule in addition to implementing the server requirements. When a HIPAA-covered health plan or its agent elects to implement the client requirements as specified in the CAQH CORE Connectivity Rule it must comply with all requirements specified in Sections 4.2, 4.3, 4.4, 4.5, 4.6, 5 and all respective Subsections.

A HIPAA-covered health plan or its agent conducting the X12 v5010 820 transaction is required to conform to the processing mode requirements specified in this section regardless of any other connectivity modes and methods used between trading partners.

Back to Top
Do the rules have requirements for a health plan that retrieves or pulls the X12 v5010 820 from another entity that is acting as a server?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:07
Do the rules have requirements for a health plan that retrieves or pulls the X12 v5010 820 from another entity that is acting as a server?

Yes. As stated in Section 4.1 of the CAQH CORE Premium Payment (820) Infrastructure Rule, “when a HIPAA-covered health plan or its agent elects to implement the client requirements as specified in the CAQH CORE Connectivity Rule it must comply with all requirements specified in Sections 4.2, 4.3, 4.4, 4.5, 4.6, 5 and all respective Subsections.”

Back to Top
Why does this “Elapsed Time for Enrollment System Processing of Received Premium Payment Data” requirement exist?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:08
Why does this “Elapsed Time for Enrollment System Processing of Received Premium Payment Data” requirement exist?

The intent of this requirement is to ensure that the health plan updates its internal enrollment application systems on a timely basis. Thus, when a provider tries to verify eligibility or submits a claim, the health plan can base its response or claim processing on more timely data which may reduce claim rejection/denial, coordination of benefit or other issues. 

Back to Top
What my entity transmits or receives premium payment information is in something other than an X12 v5010 820 (ex. Excel spreadsheet, an XML document, a proprietary flat file, etc.) do the CAQH CORE Premium Payment (820) Infrastructure Rule still apply?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:08
What my entity transmits or receives premium payment information is in something other than an X12 v5010 820 (ex. Excel spreadsheet, an XML document, a proprietary flat file, etc.) do the CAQH CORE Premium Payment (820) Infrastructure Rule still apply?

As stated in Section 3 of the CAQH CORE Connectivity Rule, the rule only “applies when a HIPAA-covered health plan or its agent uses, conducts, or processes the X12 v5010 820 transaction.” If something other than an X12 v5010 820 is received or transmitted, e.g., an Excel spreadsheet, an XML document, a proprietary file flat, etc., then CAQH CORE Premium Payment (820) Infrastructure Rule does not apply.

Back to Top
Can a clearinghouse or vendor act on behalf of a health plan for providing X12 v5010 820 transaction Acknowledgments?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:09
Can a clearinghouse or vendor act on behalf of a health plan for providing X12 v5010 820 transaction Acknowledgments?

Yes. The CAQH CORE Premium Payment (820) Infrastructure Rule defines the specific requirements that HIPAA-covered health plans or their agents must satisfy. In this context, an agent is “one who agrees and is authorized to act on behalf of another, a principal, to legally bind an individual in particular business transactions with third parties pursuant to an agency relationship.” (Source: West's Encyclopedia of American Law, edition 2, Copyright 2008 The Gale Group, Inc. All rights reserved). 

Please note that a HIPAA-covered health plan or its agent must return an X12 v5010 999 Acknowledgment to indicate that a Functional Group(s) or Transaction Set(s) is accepted, accepted with errors, or rejected and must report each error detected to the most specific level of detail supported by the X12 v5010 999 Acknowledgment.

Back to Top
The TA1 Interchange Acknowledgment is described in the HIPAA Implementation Guide Appendix B: EDI Control Director. Does the CAQH CORE Premium Payment (820) Infrastructure Rule require its use?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:09
The TA1 Interchange Acknowledgment is described in the HIPAA Implementation Guide Appendix B: EDI Control Director. Does the CAQH CORE Premium Payment (820) Infrastructure Rule require its use?

No. The CAQH CORE Premium Payment (820) Infrastructure Rule does not address the use of the X12 Interchange Acknowledgement TA1.

Back to Top
Do the time frames for the CAQH CORE Premium Payment (820) Infrastructure Rule still apply if it is an especially large batch? Do the CAQH CORE Operating Rules define the batch size?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:09
Do the time frames for the CAQH CORE Premium Payment (820) Infrastructure Rule still apply if it is an especially large batch? Do the CAQH CORE Operating Rules define the batch size?

The CAQH CORE Premium Payment (820) Infrastructure Rule and the CAQH CORE Connectivity Rule do not define batch size. The maximum size of a batch file that is accepted by a Server is outside the scope of the rule; the implementer of a Server may publish its file size limit, if any, in its Connectivity Companion Guide. Therefore, the response time frame for all Acknowledgements specified when an X12 v5010 820 health plan premium payment transaction is submitted in Batch Processing Mode applies to all batches. 

Back to Top
Are there any requirements in the CAQH CORE Premium Payment (820) Infrastructure Rule regarding how often X12 v5010X218 Payroll Deducted and Other Group Premium Payment for Insurance Products (820) transaction should be submitted? (e.g., Do CAQH CORE

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:10
Are there any requirements in the CAQH CORE Premium Payment (820) Infrastructure Rule regarding how often X12 v5010X218 Payroll Deducted and Other Group Premium Payment for Insurance Products (820) transaction should be submitted? (e.g., Do CAQH CORE Operating Rules either support or exclude an entity from sending daily batches of X12 v5010 820 transactions?)

No. The CAQH CORE Premium Payment (820) Infrastructure Rule does not address the frequency of submission of X12 v5010 820 transactions in Batch Processing Mode.      

Back to Top
Is an Acknowledgement necessary if the user sends premium payment data in a proprietary (not an X12 820) format in a real time mode?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:10
Is an Acknowledgement necessary if the user sends premium payment data in a proprietary (not an X12 820) format in a real time mode?

Good business practices for electronic message exchange encourage all senders and receivers to appropriately acknowledge receipt and both acceptance/rejection and errors found in any message. Accordingly, the CAQH CORE Prior Authorization & Referrals (278) Operating Rules are focused on the conduct of the HIPAA-named X12 Transaction Sets and on the X12 standards as well. Thus, the CAQH CORE Premium Payment (820) Infrastructure Rule only addresses the use of the X12 v5010 999 Acknowledgment and when to use it when a HIPAA-covered Health Plan conducts the X12 v5010 820 transaction. Additionally, in order to become CORE-certified, an entity is required to attest to its compliance with HIPAA, which requires the use of the appropriate X12 implementation guides.

Back to Top
Are all CAQH CORE Premium Payment (820) Infrastructure Rule requirements with regard to Acknowledgement only applicable to scenarios where my organization receives data in an X12 v5010 820 format?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:11
Are all CAQH CORE Premium Payment (820) Infrastructure Rule requirements with regard to Acknowledgement only applicable to scenarios where my organization receives data in an X12 v5010 820 format?

Yes. Good business practices for electronic message exchange encourage all senders and receivers to appropriately acknowledge receipt and both acceptance/rejection and errors found in any message. Accordingly, the CAQH CORE Operating Rules are focused on the conduct of the HIPAA-named X12 Transaction Sets and on the X12 standards as well. Thus, the CAQH CORE Premium Payment (820) Infrastructure Rule only addresses the use of the X12 v5010 999 Acknowledgment and when to use it when a HIPAA-covered Health Plan conducts the X12 v5010 820 transaction. Additionally, in order to become CORE-certified, an entity is required to attest to its compliance with HIPAA, which requires the use of the appropriate X12 implementation guides.

Back to Top
My organization’s EDI system was developed in-house and does not currently support the TA1. However, our system does support the X12 v5010 999 Acknowledgment for rejected Functional Groups. Is this conformant under the CAQH CORE Premium Payment (820)

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:11
My organization’s EDI system was developed in-house and does not currently support the TA1. However, our system does support the X12 v5010 999 Acknowledgment for rejected Functional Groups. Is this conformant under the CAQH CORE Premium Payment (820) Infrastructure Rule requirements?

Yes. The CAQH CORE Premium Payment (820) Infrastructure Rule requirements address only the X12 v5010 999 Acknowledgment; therefore your organization’s system must be able to return an X12 v5010 999 Acknowledgment for all Functional Groups to indicate that the functional group(s) was either accepted, accepted with errors, or rejected. If it is unable to do so, your organization will need to remediate the system to be in conformance with the CAQH CORE Rule in order to become CORE-certified. 

Back to Top
Do the CAQH CORE Premium Payment (820) Infrastructure Rule Real Time Acknowledgement Requirements require that my organization’s system must always return an X12 v5010 999 Acknowledgment for the X12 v5010 820?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:11
Do the CAQH CORE Premium Payment (820) Infrastructure Rule Real Time Acknowledgement Requirements require that my organization’s system must always return an X12 v5010 999 Acknowledgment for the X12 v5010 820?

Yes. When a HIPAA-covered health plan or its agent receives a Functional Group of the X12 v5010 820 it must return an X12 v5010 999 Acknowledgment to indicate that the Functional Group or Transaction Set(s) is accepted, accepted with errors, or rejected. 

Back to Top
Currently my organization’s EDI system only returns a positive X12 v5010 999 Acknowledgment reporting acceptance of the X12 v5010 820 that is submitted in Real Time Processing Mode. If the Functional Group is rejected, must my system be changed to com

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:12
Currently my organization’s EDI system only returns a positive X12 v5010 999 Acknowledgment reporting acceptance of the X12 v5010 820 that is submitted in Real Time Processing Mode. If the Functional Group is rejected, must my system be changed to comply with the Real Time requirements?

Yes. Per the CAQH CORE Premium Payment (820) Infrastructure Rule, a HIPAA-covered health plan or its agent must return an X12 v5010 999 Acknowledgement to indicate that a Functional Group(s) or Transaction Set(s) is accepted, accepted with errors, or rejected, and must report each error detected to the most specific level of detail supported by the X12 v5010 999 Acknowledgement.

Back to Top
If an X12 v5010 820 is received in a batch, does the X12 v5010 999 Acknowledgment have to be returned in a batch?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:12
If an X12 v5010 820 is received in a batch, does the X12 v5010 999 Acknowledgment have to be returned in a batch?

The rule requirement addressing response time when an X12 v5010 820 is submitted in Batch Processing Mode by 9:00 pm ET on a business day only requires that a health plan have the batch of responses available by 7:00 am ET by the third business day following submission of an X12 v5010 820. The CAQH CORE 456 Rule does not specify whether or not the batch of responses must match exactly the batch of X12 v5010 820 submissions.

Back to Top
Does my organization have to send back an X12 v5010 999 Acknowledgment response if my system is down?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:13
Does my organization have to send back an X12 v5010 999 Acknowledgment response if my system is down?

As long as your system is in conformance with the CAQH CORE Premium Payment (820) Infrastructure Rule, then it is not required to send back an X12 v5010 999 Acknowledgment response, either in real time or batch when your system is down. When your system is back up such Acknowledgements should be made available to the submitter.

Back to Top
Will there be a difference in system availability requirements for Batch versus Real Time Processing Modes?
Why did the CAQH CORE Participants increase the weekly system availability requirement from 86% to 90% system availability for the CAQH CORE X Infrastructure Rule in 2022?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:13
Why did the CAQH CORE Participants increase the weekly system availability requirement from 86% to 90% system availability for the CAQH CORE X Infrastructure Rule in 2022?

Each set of CAQH CORE Operating Rules includes an infrastructure rule with requirements for system availability and reporting, including the CAQH CORE Premium Payment (820) Infrastructure Rule. In response to feedback from CAQH CORE Participants and the CAQH CORE Board, in September 2021 CAQH CORE surveyed Participating Organizations to determine where there may be consensus to update the CAQH CORE Infrastructure Operating Rule requirements to align with evolving business needs and technology. The survey focused on system availability and response time requirements across all rule sets and clear consensus emerged to update the system availability requirements across the CAQH CORE Infrastructure Rules.

Significant discussions occurred related to system availability needs. Ultimately, CORE Participants compromised by approving a new quarterly system availability requirement to accommodate large system migrations if weekly system availability was increased from 86% per calendar week to 90% per calendar week. With this weekly availability increase, the new quarterly system availability allows health plans and their agents to use 24 additional hours of system downtime per calendar quarter for system migrations, mitigations, and other system needs that may require additional downtime.

Back to Top
Is the additional 24-hour downtime available per calendar quarter required to be taken in one 24-hour period?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:14
Is the additional 24-hour downtime available per calendar quarter required to be taken in one 24-hour period?

No, the 24-hour downtime can be taken in any increment of time throughout the calendar, as needed.

Back to Top
Is the additional 24-hour downtime per calendar quarter in addition to the weekly allocated downtime?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:14
Is the additional 24-hour downtime per calendar quarter in addition to the weekly allocated downtime?

Yes, the new requirement specifies an additional 24 hours available quarterly in excess of the 17 hours weekly allowable downtime, or 10% of a calendar week.

Back to Top
Does the new quarterly system availability downtime requirement define calendar quarter?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:15
Does the new quarterly system availability downtime requirement define calendar quarter?

No. The new quarterly system availability requirement does not define calendar quarter. The definition of a calendar quarter is agreed upon between trading partners.

Back to Top
My organization includes system availability schedules in our Companion Guide. Does this satisfy the CAQH CORE Premium Payment (820) Infrastructure Rule requirements for system availability reporting?
Why was the CAQH CORE Master Companion Guide Template updated?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:16
Why was the CAQH CORE Master Companion Guide Template updated?

The CAQH CORE Master Companion Guide Template was updated to align with industry need to support X12 versions beyond v5010. As such, the CAQH CORE Master Companion Guide template was updated to be version agnostic, removing explicit references to X12 v5010 from the template.

Back to Top
Why was the Master Companion Guide Template created for entities processing premium payments?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:16
Why was the Master Companion Guide Template created for entities processing premium payments?

For many years health plans independently created companion guides that often varied in format and structure. Such variance can be confusing to trading partners and providers. CAQH CORE adapted its CAQH CORE Master Companion Guide Template for CAQH CORE Premium Payment (820) Infrastructure Rule based on the CAQH/WEDI Best Practices Companion Guide Template, with input from multiple health plans, system vendors, provider representatives and healthcare/HIPAA industry experts. The CAQH CORE Master Companion Guide Template organizes information into several simple sections and provides for a common information flow and format, while at the same time giving health plans the flexibility to tailor the document to meet their particular needs. The CAQH CORE Master Companion Guide Template may be used for all HIPAA-mandated Transaction Sets.

Back to Top
Does the CAQH CORE Premium Payment (820) Infrastructure Rule require HIPAA-covered entities to publish a Companion Guide if they do not currently do so?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:17
Does the CAQH CORE Premium Payment (820) Infrastructure Rule require HIPAA-covered entities to publish a Companion Guide if they do not currently do so?

No. Section 4.9 of the CAQH CORE Premium Payment (820) Infrastructure Rule specifies that should an entity publish a companion guide it must conform to the format/flow as defined in the CAQH CORE Master Companion Guide Template.

Back to Top
Can I combine multiple Transaction Sets in a single companion guide?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 15:17
Can I combine multiple Transaction Sets in a single companion guide?

Yes. Entities may combine their companion guides for separate transactions into a single document. The flow and format of the CAQH CORE Master Companion Guide Template would still need to be followed, but sections would need to be repeated, tables added for each additional transaction, etc., without altering the flow and format.

Back to Top