Does the CAQH CORE Benefit Enrollment (834) 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 Benefit Enrollment (834) 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.

My organization includes system availability schedules in our Companion Guide. Does this satisfy the CAQH CORE Benefit Enrollment (834) Infrastructure Rule requirements for system availability reporting?

Yes, HIPAA-covered health plans (or information sources), clearinghouses/switches, or other intermediaries must publish their regularly scheduled system downtime in an appropriate manner (e.g., on websites or in Companion Guides). This allows the healthcare provider to better manage staffing levels.

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?

Will there be a difference in system availability requirements for Batch versus Real Time Processing Modes?

No. The system availability requirements apply to Batch and Real Time Processing Modes, with no difference in system availability based on the processing mode. CAQH CORE will conduct research and environmental scans to obtain data on the feasibility of separate system availability requirements in potential future infrastructure updates, as separate requirements may make better business sense as the industry moves to more API-driven interactions between providers and health plans.