CORE
CAQH CORE Launches New Participant Dashboard
Platform offers easy access to work group information, resources and events.
In February 2021, CAQH CORE launched a new CAQH CORE Participant Dashboard. This user-friendly platform will simplify how participants can engage with their current work groups and join new ones. It also includes a global calendar of all CAQH CORE events, and enables easy access to all work group documentation, rosters and meeting information.
If you are a CAQH CORE participant and did not receive an email with information about how to register, please email core@caqh.org.
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.
New CAQH CORE Operating Rules to Improve Patient Attribution Data Sharing and Connectivity
Join the CAQH CORE Team to learn more about new and updated CAQH CORE Operating Rules approved with overwhelming support in late 2020 for industry implementation, including:
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.
Eligibility & Benefits Operating Rules
The CAQH CORE Eligibility & Benefits Operating Rules enhance the exchange of eligibility information between health plans and provider through consistent infrastructure and data content requirements including the exchange of patient financial information.
Frequently Asked Questions
CAQH CORE has updated its operating rule structure. The CAQH CORE FAQs are in the process of being updated to align with the new structure. CAQH CORE appreciates your patience as these updates are made.
Resource Library
CAQH CORE has produced a variety of online resources to provide education on operating rule implementation and CAQH CORE initiatives.
e-LEARNING RESOURCES
CAQH CORE has developed interactive tools and dashboards on topics of interest to industry stakeholders.
