1. Do the CAQH CORE Eligibility & Benefits (270/271) Operating Rules apply to Direct Data Entry (DDE)?
No. The CAQH CORE Eligibility & Benefits (270/271) Operating Rules do not apply to DDE transactions.
2. What resources are available to assist my organization with implementation of the CAQH CORE Eligibility & Benefits (270/271) Operating Rules?
CAQH CORE has several resources and tools available at no cost to assist entities with implementation of the CAQH CORE Eligibility & Benefits (270/271) Operating Rules, including:
3. What CAQH CORE Eligibility & Benefits (270/271) Operating Rules are mandated under the ACA?
As the ACA Administrative Simplification provisions build on and update the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), ACA §1104 requires all HIPAA- covered entities to comply with the ACA-mandated standards and applicable operating rules by their compliance dates.
4. What entities should implement the CAQH CORE Eligibility & Benefits (270/271) Operating Rules?
The CAQH CORE Eligibility & Benefits Operating Rules apply to all HIPAA covered entities or their agents that conduct the following transactions:
5. What do the CAQH CORE Eligibility & Benefits (270/271) Operating Rules address?
The CAQH CORE Eligibility & Benefits (270/271) Operating Rules address the following:
6. What entities should implement the CAQH CORE Eligibility & Benefits Operating Rules?
As the ACA Administrative Simplification provisions build on and update the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), ACA Section 1104 requires all HIPAA- covered entities to comply with the ACA-mandated standards and applicable operating rules by their compliance dates.
7. Which CAQH CORE Eligibility & Benefit Operating Rules are federally mandated?
All HIPAA-covered entities are required by Federal law to adopt the CAQH CORE Eligibility & Benefits Operating Rules by January 1, 2013 for the X12 270/271 eligibility transaction.
8. What do the CAQH CORE Eligibility Benefits Operating Rules address?
The CAQH CORE Eligibility & Benefits Operating Rules streamline the way eligibility/benefits and attribution information is exchanged electronically between health plans and providers. Easier, more reliable access to this information at the point of care can reduce the amount of time providers spend on administration by improving the accuracy of claims submitted and providing enhanced information on patient financial responsibility.