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.

Yes. Entities may combine their companion guides for separate transactions into a single document. The flow and format of the CAQH CORE Master Companion Guide Template would still need to be followed, but sections would need to be repeated, tables added for each additional transaction, etc., without altering the flow and format.

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.

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.

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.

Yes. HIPAA-covered health plans (or information sources), clearinghouses/switches or other intermediaries must publish their regularly scheduled system downtime in an appropriate manner (e.g., on websites or in Companion Guides). This allows the submitting entity to better manage staffing levels and expectations for the delivery of the X12 v5010 820 transaction. Additionally, the CAQH CORE Premium Payment (820) Infrastructure Rule outlines requirements for reporting/publishing non-routine downtimes and unscheduled/emergency downtimes.

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 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.