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.
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.
Why was the Master Companion Guide Template created for entities conducting benefit enrollment electronically?
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.
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.
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.
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.
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 Benefit Enrollment (834) 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.
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.