The CAQH CORE Master Companion Guide Template was updated to align with industry need to support X12 versions beyond v5010. As such, the CAQH CORE Master Companion Guide template was updated to be version agnostic, removing explicit references to X12 v5010 from the template.
No. The new quarterly system availability requirement does not define calendar quarter. The definition of a calendar quarter is agreed upon between trading partners.
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.
No, the 24-hour downtime can be taken in any increment of time throughout the calendar, as needed.
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.
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.
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).
The 24 hours of additional quarterly downtime can be taken in any increment of time throughout the calendar quarter to allow for larger system upgrades, as needed.
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.
No. Your organization is only required to submit to the authorized testing vendor:
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.