5. Why did the CAQH CORE Participants increase the weekly system availability requirement from 86% to 90% system availability for the CAQH CORE Claim Status (276/277) 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 Claim Status (276/277) 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.

6. 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.

How does an entity determine which version of CAQH CORE Connectivity to use when implementing the HIPAA mandated CAQH CORE Eligibility & Benefits (270/271) Infrastructure Rules?

All HIPAA covered entities are required to support CAQH CORE Connectivity vC1.1.0 and vC2.2.0 for the HIPAA-mandated claim status transaction (please see Mandated Operating Rules webpage for full list of federally mandated operating rules with original naming conventions).    

Additionally, all CAQH CORE Infrastructure Operating Rules require use of “most recent published and CAQH CORE adopted version of the CAQH CORE Connectivity Rule” (please see the CAQH CORE Connectivity webpage for more information).    

8. The system availability update allows for 17 hours of scheduled downtime available per calendar week, are there any limitations on how my organization may choose to schedule the allowable additional 24 hours of downtime available per calendar quarter?

9. Does the CAQH CORE Claim Status Operating Rule, Section 4.7 require health plans to request approval from ASC X12 prior to publication of their CORE-compliant Companion Guide(s)?

No. The Federally mandated CAQH CORE Claim Status Operating Rules, as adopted by HHS, do not require any entity to submit its Companion Guide to ASC X12 for review and approval prior to publication.

10. Will all the detailed content of my organization’s X12 276/277 Companion Guide be analyzed and evaluated for CORE Certification testing?

No. Your organization is only required to submit to the authorized testing vendor:

  1. The guide’s table of contents and
  2. A page showing your organization’s requirements for the presentation of segments, data elements and codes.

Your selected CAQH CORE-authorized testing vendor will assess these documents to determine that your Companion Guide conforms to the CORE required flow and format.