CORE

CAQH CORE and X12 Webinar Series: 835 Transaction, Standard & Operating Rules for an Advanced User

The X12 005010X221A1 Health Care Claim Payment/Advice (835) TR3 Implementation Guide is the HIPAA-adopted standard for claim payment/advice. This guide provides standardized data content for creation and use of the 835 transaction. The 835 is used throughout the healthcare marketplace by providers to post claim payments and adjustments to their accounting systems. CAQH CORE Payment & Remittance Operating Rules help the industry more effectively implement and use the 835 transaction to understand payment decisions and optimize denial management.

Training Session on Annual Industry Opportunity to Make Updates to CORE Code Combinations – 2021 Market-based Review

The CORE Code Combinations organize claim denial and adjustment codes into unique business scenarios for more consistent code use across industry. CAQH CORE conducts a biennial Market-based Review (MBR) of the CORE Code Combinations to address industry business needs.

Current Initiatives for CAQH CORE Participants

CAQH CORE Participating Organizations help ensure that operating rules continue to meet evolving business needs, by engaging in the rule development process and maintenance of existing operating rules. Work groups are open to all CAQH CORE Participating Organizations, and multiple individuals from the same Participating Organization may join. Because each organization has only one vote, participants collaborate with their colleagues to submit an organizational-level response during voting periods. 

Attributed Patient Roster Operating Rules

Attributed Patient Rosters are used by health plans, providers and employers to share lists of patients attributed to a provider under a value-based contract. The CAQH CORE Attributed Patient Roster Operating Rules establish consistent expectations for the electronic exchange of attributed patient rosters among stakeholders at predictable intervals by supporting consistent data content, infrastructure and a connectivity safe harbor using the X12 005010X318 Member Plan Reporting (834) Transaction.