The system availability update allows for 17 hours of scheduled downtime available per calendar week in addition to the weekly system availability requirement. Are there any limitations on how my organization may choose to schedule the allowable additiona

Does the CAQH CORE Premium Payment (820) 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 Premium Payment (820) 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 processing premium payments?

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. CAQH CORE adapted its CAQH CORE Master Companion Guide Template for CAQH CORE Premium Payment (820) Infrastructure Rule based on the CAQH/WEDI Best Practices Companion Guide Template, with input from multiple health plans, system vendors, provider representatives and healthcare/HIPAA industry experts.

My organization includes system availability schedules in our Companion Guide. Does this satisfy the CAQH CORE Premium Payment (820) Infrastructure Rule requirements for system availability reporting?

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 Premium Payment (820) 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.