IV. CAQH CORE Connectivity Rule vC4.0.0

1. What exchange methods are supported by the CAQH CORE Connectivity Rule vC4.0.0 and what are the implementation requirements for my organization?

Read more about 1. What exchange methods are supported by the CAQH CORE Connectivity Rule vC4.0.0 and what are the implementation requirements for my organization?

The CAQH CORE Connectivity Rule vC4.0.0 support the exchange of two connectivity methods, SOAP and REST. The CAQH CORE Connectivity Rule vC4.0.0 outlines requirements individually for each exchange method.

The CAQH CORE Connectivity Rule vC4.0.0 is a CAQH CORE Safe Harbor connectivity method meaning that:

2. When would a provider system act as both a client and a server and therefore need to comply with the requirements for both REST and SOAP exchanges rather than either REST or SOAP?

Read more about 2. When would a provider system act as both a client and a server and therefore need to comply with the requirements for both REST and SOAP exchanges rather than either REST or SOAP?

In the instance that a provider or provider vendor implements a server (e.g., message receiver), it must support both exchange methods specified by the CAQH CORE Connectivity Rule vC4.0.0 (SOAP and REST).

3. Section 3.3 When the Rule Applies lists X12 v6020 275 and X12 v5010 278. Why does the section have differing versions for the 275 and 278 transactions?

Read more about 3. Section 3.3 When the Rule Applies lists X12 v6020 275 and X12 v5010 278. Why does the section have differing versions for the 275 and 278 transactions?

Since v5010X217 278 is currently specified in the CAQH CORE Prior Authorization Rules and is the HIPAA-mandated version, we recommend continued support for v5010 for consistency across existing CAQH CORE Operating Rules. Given there is no HIPAA-mandated standard for attachments, the X12 v6020 275 is specified in this rule because it is the standard that was recommended for adoption by X12 to the National Committee on Vital Health Statistics.

4. Do the requirements included in the CAQH CORE Connectivity Rule vC4.0.0 apply only to the transactions conducted by a particular entity?

Read more about 4. Do the requirements included in the CAQH CORE Connectivity Rule vC4.0.0 apply only to the transactions conducted by a particular entity?

Yes. Similar to the previous CAQH CORE Connectivity Rules, the requirements only apply to the transactions conducted by a specific entity. This means that if an entity does not support one of the listed transactions, they are not required to support the connectivity requirements for that particular transaction.

5. When will the industry be required to implement changes to CAQH CORE Safe Harbor Connectivity made in this version of the rules?

Read more about 5. When will the industry be required to implement changes to CAQH CORE Safe Harbor Connectivity made in this version of the rules?

Currently, CAQH CORE Connectivity Rule vC3.1.0, including the updated CAQH CORE Connectivity Rule vC4.0.0, are voluntary for industry adoption, while CAQH CORE Connectivity Rules vC1.1.0 and vC2.2.0 are ACA-mandated fo

6. How were the transactions listed in the Section 3.3 When the Rule Applies chosen?

Read more about 6. How were the transactions listed in the Section 3.3 When the Rule Applies chosen?

To create a single, uniform CAQH CORE Connectivity Rule, Section 3.3 When this Rule Applies of

7. Can an organization implement a standard that is a higher version than what is listed in Section 3.2 Standards Used in this Rule (e.g., TLS 1.3)?

Read more about 7. Can an organization implement a standard that is a higher version than what is listed in Section 3.2 Standards Used in this Rule (e.g., TLS 1.3)?

Yes. Organizations are not precluded from supporting versions higher than what is minimally specified in Section 3.2 Standards Used in this Rule (e.g., TLS 1.2 or higher).

8. Is the CAQH CORE Connectivity Rule vC4.0.0 payload agnostic?

Read more about 8. Is the CAQH CORE Connectivity Rule vC4.0.0 payload agnostic?

Yes. The CAQH CORE Connectivity Rule vC4.0.0 is designed to be payload agnostic. The ACA-mandated CAQH CORE Connectivity Rule vC2.2.0 and voluntary CAQH CORE Connectivity Rule vC3.1.0 support the exchange of both HIPAA-mandated and non-HIPAA mandated transactions.

9. Does the CAQH CORE Connectivity Rule vC4.0.0 support all electronic healthcare transactions?

Read more about 9. Does the CAQH CORE Connectivity Rule vC4.0.0 support all electronic healthcare transactions?

The aim of the CAQH CORE Connectivity Rule Update is to create a single, uniform connectivity rule with requirements that support all electronic healthcare transactions.