Will the CAQH CORE Attachments Claims Infrastructure Rule require providers to use the X12 275 transaction to send attachments to support a claim submission?

No. Providers are not required to use non-HIPAA mandated transactions, including the X12 v6020X314 275 transaction, to send an attachment or additional documentation. If providers do choose to use X12 275 to send an attachment, they should follow the relevant operating rule requirements.

Why was the X12 v5010 chosen for Claims Transactions when the rule supports v6020 of the Attachments transaction?

Since v5010X217 278 is currently specified in the CAQH CORE Prior Authorization Operating Rules and is the HIPAA-mandated version, the Attachments Subgroup – Prior Authorization Use Case voted, using a consensus-driven approach including straw polls, feedback forms, and discussions, to support X12 v5010 278 for consistency across existing CAQH CORE Operating Rules.

How will compliance regarding Attachments Claims Operating Rules be enforced?

In 2022, the Attachments Claims Operating Rules were published to industry for voluntary adoption. If an organization decides to pursue voluntary CORE Certification on the CAQH CORE Attachments Operating Rules, they have a maximum timeframe of 180 days to complete certification testing on the rule requirement after submission of the CAQH CORE Pledge to adopt the rule. CORE-certified entities are then required to recertify every three years.

How will compliance regarding Attachments Claims Operating Rules be enforced?

In 2022, the Attachments Claims Operating Rules were published to industry for voluntary adoption. If an organization decides to pursue voluntary CORE Certification on the CAQH CORE Attachments Operating Rules, they have a maximum timeframe of 180 days to complete certification testing on the rule requirement after submission of the CAQH CORE Pledge to adopt the rule. CORE-certified entities are then required to recertify every three years.

My organization is a Health Plan. Which rule requirements does my organization have to test for to achieve CORE Certification on Benefit Enrollment Operating Rules?

A Health Plan seeking CORE Certification on the CAQH CORE Benefit Enrollment Operating Rules must undergo CAQH CORE Certification Testing in accordance with the

My organization is a health plan. We do not currently support some of the HIPAA-mandated transaction standards addressed by the CAQH CORE Operating Rules. Do the CAQH CORE Operating Rules require us to implement these HIPAA-mandated transactions?

The CAQH CORE Operating Rules do not require any entity to implement any of the HIPAA-mandated healthcare administrative transactions.

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