The CAQH CORE Benefit Enrollment Operating Rules apply to all HIPAA covered entities that conduct the following transactions:
X12 5010X220 Benefit and Enrollment Maintenance (834) transaction
ACA Section 1104 requires HHS to adopt a standard, and applicable operating rules, for the health claims attachments transaction. To date, HHS has not adopted a standard for health claims attachments or indicated what standard(s) it might consider for the transaction.
From December 2013 – June 2015, CAQH CORE Participants used the open CAQH CORE rules-making process to produce a set of operating rules for the following transactions: health claims or equivalent encounter information, health plan enrollment/disenrollment, health plan premium payments and referral certification and authorization.
On September 12, 2012, the Secretary of HHS concurred with the recommendation from the National Committee on Vital and Health Statistics (NCVHS) that CAQH CORE be designated the authoring entity for the remaining operating rules mandated under ACA Section 1104.
ACA Section 1104 requires the Secretary of the Department of Health and Human Services (HHS) to adopt and regularly update operating rules for each of the HIPAA-mandated healthcare administrative transactions.