Instructions https://www.caqh.org/ en CAQH ProView Resources https://www.caqh.org/solutions/caqh-proview-resources <span>CAQH ProView Resources</span> <span><span lang="" about="/users/mwoolstoncaqhorg" typeof="schema:Person" property="schema:name" datatype="">mwoolston@caqh.org</span></span> <span>Wed, 12/14/2016 - 15:15</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><div class="accordion"> <h3>FAQs</h3> <div> <h5>In which states is CAQH ProView available?</h5> <p style="margin-left: 40px;">View a <a class="ga-event" description="" gaevent="Binary Assets" href="https://www.caqh.org/sites/default/files/solutions/proview/resource/proview-states.pptx.pptx?token=kq8wg0jr" target="_blank" title="CAQH ProView form state map" type="application/vnd.openxmlformats-officedocument.presentationml.presentation; length=646439">state map</a> showing where CAQH ProView is designated, voluntarily deployed, or supporting manadated or unique state forms.</p> <h3>Participating Organization FAQs</h3> <h5>How often are providers required to re-attest?</h5> <p style="margin-left: 40px;">Every 120 days, unless they practice in Illinois in which case they must attest every 180 days.</p> <h5>Why doesn’t my provider have to upload a new AAR (Attestation, Authorization, and Release) every 120/180 days?</h5> <p style="margin-left: 40px;"><a href="http://ncqa.force.com/faq/FaqArticles">NCQA</a> has approved CAQH ProView’s electronic attestation method, which extends the original wet signature and places a provider’s electronic attestation date at the top of the AAR document. </p> <h5>How often does CAQH outreach to providers reminding them to attest?:</h5> <p style="margin-left: 40px;">Re-attestation reminder emails are sent on the following schedule:</p> <ul><li style="margin-left: 1in;">15 days prior to expiration</li> <li style="margin-left: 1in;">10 days prior to expiration</li> <li style="margin-left: 1in;">5 days prior to expiration</li> </ul><p style="margin-left: 40px;">If no re-attestation has occurred, a provider status will be updated to “Expired” on the day after the re-attestation was due.  Providers in expired status will receive the following notices:</p> <ul><li style="margin-left: 1in;">Day after provider is placed in expired status</li> <li style="margin-left: 1in;">14 days after expired </li> <li style="margin-left: 1in;">28 days after expired</li> <li style="margin-left: 1in;">42 days after expired – final notice. </li> </ul><h5>How often am I billed for services?</h5> <p style="margin-left: 40px;">CAQH looks at a number of factors when billing for providers. To be billed for a particular provider, <strong><u>ALL</u></strong> of the following must be met::</p> <ol style="margin-left: 80px;"><li>Provider is Active on your Roster. </li> <li>Provider is in Re-attestation or Initial Profile Complete status at the time of their Anniversary Date.</li> <li>Provider has authorized your plan to view their credentialing application.</li> </ol><p style="margin-left: 40px;">Once all criteria is confirmed, CAQH bills once a year for each provider on your roster in the month of the provider's anniversary date (AD).</p> <p style="margin-left: 40px;">Your organization may also pay an annual fee of $3,000 that is billed once a year around the time your agreement was initiated with CAQH ProView.</p> <h5>Where can I locate my invoices?</h5> <p style="margin-left:.5in;">If you are a CAQH ProView Plan Administrator, Back-up Plan Administrator or Billing Administrator, you can securely access billing information directly through CAQH ProView. Simply log in and go to the <em>Files and Reports</em> tab. Then click on <em>Billing Reports</em> to easily retrieve your Invoices.</p> <p style="margin-left:.5in;">In addition, you will find <em>Application Reports</em> listing the providers that are billable on each invoice you receive. If you would like to see your account balance, AR aging, credits available, or a list of open invoices, just view your <em>Statement of Accounts Report</em>.</p> <p> </p> <h3>Provider and Practice Manager FAQs</h3> <h5>How often do I need to attest to my CAQH ProView information?</h5> <p style="margin-left: 40px;">Every 120 days, unless you practice in Illinois in which case you must attest every 180 days.</p> <h5>How long will it take my attestation to go through?</h5> <p style="margin-left: 40px;">Your attestation is processed in real time. Document approval may take up to three business days.</p> <h5>How long will it take my documents to get approved?</h5> <p style="margin-left: 40px;">Documents uploaded via the CAQH ProView Provider Portal will be approved within three business days.</p> <h5>Why did my document fail?</h5> <p style="margin-left: 40px;">Documents usually fail if they are not the correct file type, if they are not signed or are illegible. Documents may also fail if information on your account does not match the information on the document being submitted. For more specific information about document failure, please contact the Provider Support Center.  You may speak with a representative via Chat through the CAQH ProView system or you may call 1-888-599-1771.</p> <h5>Why do I have to update my data again, even though I just attested?</h5> <p style="margin-left: 40px;">CAQH ProView routinely makes system updates to maintain the most current and consistent provider data for uses including credentialing and provider directories. Based on these updates, the system may ask you to enter or update additional information in order to reattest. However, once you have attested, your information will remain updated in CAQH ProView until the time a reattestation is requested.</p> <h5>Why did my information not save when I updated it?</h5> <p style="margin-left: 40px;">There are red ‘Save’ and ‘Save and Continue’ buttons at the bottom of every page of your application in CAQH ProView. Use these buttons as you are working through your application and every time you make any changes to your data in order to save your updated information. Once you have made all of your updates and are ready to reattest, please then follow the CAQH ProView attestation steps.</p> <h5>Why am I not receiving emails from CAQH ProView?</h5> <p style="margin-left: 40px;">CAQH ProView sends email notifications to your Primary Email Address and to two additional email addresses if specified. Please ensure that your email address is listed as the Primary Email on your account. You may also want to check that our system emails are not being caught in your Spam/Clutter folders—please make <a href="mailto:ProviewSystemAdministrator@proview.caqh.org">ProviewSystemAdministrator@proview.caqh.org</a> a trusted sender.</p> </div> <h3>User Guides</h3> <div> <ul><li>For Participating Organizations: <ul><li>Please log in to CAQH ProView and navigate to the Resources page on the upper right-hand side for the latest user guides.</li> </ul></li> <li>For Providers: <ul><li>Please go to <a href="https://proview.caqh.org/pr">https://proview.caqh.org/pr</a> and download the user guides from the lower left-hand side of the screen.</li> </ul></li> <li>For Practice Managers: <ul><li>Please go to <a href="https://proview.caqh.org/pm">https://proview.caqh.org/pm</a> and download the user guides from the lower left-hand side of the screen.</li> </ul></li> </ul><p> </p> </div> <h3>Specification Documents</h3> <div> <p>Many resources are available directly on CAQH ProView. <a href="https://proview.caqh.org/Login/">Log in to CAQH ProView</a> to access the following:</p> <ul><li><strong>Roster Data Exchange Guidelines</strong>: Outlines the required format and process for a Participating Organization to submit a Roster of providers to CAQH ProView.</li> <li><strong>Roster Header Templates</strong>:  Excel Templates to assist Participating Organizations in creating Rosters. These documents can be converted to txt format for submission.</li> <li><strong>Domain Table</strong>: Outlines the reference data that exists in the Provider Profile and will be delivered in the Extracts.</li> <li><strong>API Specifications</strong>: Outlines the Provider Data available via API, and the process for a Participating Organization to retrieve data from the API Web Service.</li> <li><strong>sFTP</strong>: Outlines how a Participating Organization can use the sFTP to submit Rosters and receive Extracts.</li> <li><strong>Extract Data Dictionary</strong>: Outlines the mapping of the Provider Profile fields to the Extract fields.</li> <li><strong>Sample data files</strong>: Sample Extracts from CAQH ProView for a Participating Organization to use for testing.</li> </ul></div> <h3>Technical Instructions</h3> <div> <ul><li> - Explanation of how to open CAQH ASCII (.txt) files in Microsoft Excel.</li> <li><a href="/sites/default/files/solutions/proview/resource/excel-to-.txt.pdf">Converting Excel files to .TXT</a> - Explanation of how to convert your Microsft Excel roster file to a tab-delimited text file.</li> <li> - When using your Return Roster in Microsoft Excel to look at provider Anniversary Dates, this formula can be used to convert the date into a more sortable format.</li> <!--<li><span style="text-indent: -15px;">.XML/.XLS/.XLSM <em><strong>to</strong></em> Access</span></li>--></ul></div> <h3>Regulatory</h3> <div> <p>Please log in to CAQH ProView and navigate to the Resources page on the upper right-hand side for the latest regulatory information.</p> </div> <h3>CAQH ProView System Update Release Archive</h3> <div> <p>Below are the final emails distributed announcing details related to each CAQH ProView release over the past year:</p> <p>April 20, 2020</p> <div class="long-list-text"> <ul><li><a href="https://www.caqh.org/solutions/caqh-solutions-release-archive-participating-organizations#4.20.20">Participating Organizations</a></li> </ul></div> <p>March 16, 2020</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-solutions-release-archive-participating-organizations#3.16.2020">Participating Organizations</a></li> </ul><p>February 18, 2020</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-solutions-release-archive-participating-organizations#2.18.2020">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#2.18.2020">Practice Managers</a></li> </ul><p>December 9, 2019</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-solutions-release-archive-participating-organizations#12.9.2019">Participating Organizations</a></li> </ul><p>October 21, 2019</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-solutions-release-archive-participating-organizations#10.21.2019">Participating Organizations</a> </li> </ul><p>August 12, 2019</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-solutions-release-archive-participating-organizations#8.12.2019">Participating Organizations</a></li> </ul><p>July 15, 2019</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#7.15.2019">Participating Organizations </a></li> <li><a href="https://conta.cc/32rOjHU">Practice Managers</a></li> </ul><p>Mary 28, 2019</p> <ul><li><a href="https://conta.cc/2EzCtAX">Participating Organizations</a></li> <li><a href="https://myemail.constantcontact.com/CAQH-Solutions-Update---May-28--2019.html?soid=1121725806339&amp;aid=AIOV9jRGsjE">Practice Managers</a></li> </ul><p>March 25, 2019</p> <ul><li><a href="https://conta.cc/2JF1vnx">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#3.25.2019">Practice Managers</a></li> </ul><p>February 4, 2019</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#1.21.2019">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#1.21.2019">Practice Managers</a></li> </ul><p>December 10, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#12.10.2018">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#12.10.2018">Practice Managers</a></li> </ul><p>October 22, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#10.22.2018">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#10.22.2018">Practice Managers </a></li> </ul><p>September 24, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#09.24.2018">Participating Organizations</a> </li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#09.24.2018">Practice Managers</a></li> </ul><p>August 20, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#08.20.2018">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#08.20.2018">Practice Managers</a></li> </ul><p>July 23, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#07.23.2018">Participating Organizatons</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#07.23.2018">Practice Managers </a></li> </ul><p>June 11, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#06.11.2018">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#06.11.2018">Practice Managers </a></li> </ul><p>April 16, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#04.16.2018">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#04.16.2018">Practice Managers</a></li> </ul><p>February 20, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#02.20.2018">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#02.20.2018">Practice Managers</a> </li> </ul><p>January 22, 2018</p> <ul><li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-participating-organizations#01.22.2018">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#01.22.2018">Practice Managers</a></li> </ul><!--START HIDE CODE <p>December 4, 2017</p> <ul> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive#12.4.2017">Participating Organizations</a></li> </ul> <p>October 30, 2017</p> <ul> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive#10.30.2017">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#10.31.2017">Practice Managers</a></li> </ul> <p>September 25, 2017</p> <ul> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive#09.25.2017">Participating Organizations</a></li> </ul> <p>August 28, 2017</p> <ul> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive#08.28.2017">Participating Organizations</a></li> <li><a href="http://conta.cc/2f8W2Dq">Practice Managers</a></li> </ul> <p>July 31, 2017</p> <ul> <li><a href="http://conta.cc/2vKVMRq">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#7.31.2017">Practice Managers</a></li> </ul> <p>June 22, 2017</p> <ul> <li><a href="http://conta.cc/2tcgNGv">Participating Organizations</a></li> <li><a href="http://conta.cc/2tNyb11">Practice Managers</a></li> </ul> <p>May 22, 2017</p> <ul> <li><a href="http://conta.cc/2tcpKzi">Participating Organizations</a></li> <li><a href="http://conta.cc/2pYFJN2">Practice Managers</a></li> </ul> <p>April 25, 2017</p> <ul> <li><a href="http://conta.cc/2tcuPHX">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#4.25.2017">Practice Managers</a></li> </ul> <p>January 17, 2017</p> <ul> <li><a href="http://conta.cc/2iG7lXS">Participating Organizations</a></li> <li><a href="https://www.caqh.org/solutions/caqh-proview-release-archive-providers-and-practice-managers#1.17.2017">Practice Managers</a></li> </ul> <p>November 14, 2016</p> <ul> <li><a href="http://conta.cc/2iKywzu">Participating Organizations</a></li> <li><a href="http://conta.cc/2fT0031">Practice Managers</a></li> </ul> <p>October 17, 2016</p> <ul> <li><a href="http://conta.cc/2iVW6aB">Participating Organizations</a></li> <li><a href="http://conta.cc/2emEkK5">Practice Managers</a></li> </ul> <p>August 1, 2016</p> <ul> <li><a href="http://conta.cc/2iW2K0h">Participating Organizations</a></li> <li><a href="http://conta.cc/2iW4LK5">Practice Managers</a></li> </ul> <p>June 20, 2016</p> <ul> <li><a href="http://conta.cc/2iW4FCi">Participating Organizations</a></li> <li><a href="http://conta.cc/2iW5IlD">Practice Managers</a></li> </ul> <p>March 28, 2016</p> <ul> <li><a href="http://conta.cc/2iWcGHk">Participating Organizations</a></li> <li><a href="http://conta.cc/2iW8nMg">Practice Managers</a></li> </ul> <p>January 14, 2016</p> <ul> <li><a href="http://conta.cc/2iW5U4x">Participating Organizations</a></li> <li><a href="http://conta.cc/2igg65E">Practice Managers</a></li> </ul> END HIDE CODE--></div> <h3>Instructional Videos and Webinars</h3> <div> <p>Overviews:</p> <ul><li><a href="https://www.youtube.com/watch?v=FMlRaz1EzTU&amp;t=20s">CAQH ProView for Providers</a></li> <li><a href="https://www.youtube.com/watch?v=ZpZwSnTDh-s&amp;t=6s">CAQH ProView for Practice Managers</a></li> <li><a href="https://www.youtube.com/watch?v=E06k-SdJhyM&amp;t=5s">CAQH ProView Provider Portal Overview</a></li> <li><a href="https://www.youtube.com/watch?v=TAF62rYbhm0&amp;t=88s">CAQH ProView Practice Manager Portal</a></li> <li><a href="https://www.youtube.com/watch?v=b1wR4ZWtWJQ">CAQH ProView Webcast: Taking Credentialing to New Heights and Beyond</a></li> <li><a href="https://www.youtube.com/watch?v=jANIlEBjcNg">Streamlining Dental Provider Data Collection with CAQH ProView</a></li> <li><a href="https://youtu.be/evgGO8G52mM">About CAQH ProView Standard Extracts</a> (NEW)</li> </ul><p>How To's:</p> <ul><li><a href="https://www.youtube.com/watch?v=Sp83Y3YRb60">How to Upload Supporting Documents in CAQH ProView</a></li> <li><a href="https://www.youtube.com/watch?v=mKQ6Q1PImig&amp;t=4s">How to Attest and Re-Attest in CAQH ProView</a></li> <li><a href="https://www.youtube.com/watch?v=OzHIAzaMjlg&amp;t=54s">How to Reset Your Password in CAQH ProView</a></li> <li><a href="https://www.youtube.com/watch?v=C-4Z5BG1_y0&amp;t=7s">How to Log-in for the First Time - CAQH ProView </a></li> <li><a href="https://youtu.be/vXOGoE3z398">How to Convert CAQH ProView Pipe Delimited TXT Files To Excel</a> (NEW)</li> </ul></div> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/instructions" hreflang="en">Instructions</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-organization-type field--type-entity-reference field--label-inline"> <div class="field--label">Organization Type</div> <div class="field--item"><a href="/organization/health-plans" hreflang="en">Health plans</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-proview" hreflang="en">CAQH ProView</a></div> </div> Wed, 14 Dec 2016 20:15:23 +0000 mwoolston@caqh.org 1846 at https://www.caqh.org Accessing CAQH Websites https://www.caqh.org/about/june-24-2016-accessing-caqh-websites <span>Accessing CAQH Websites</span> <span><span lang="" about="/users/mwoolstoncaqhorg" typeof="schema:Person" property="schema:name" datatype="">mwoolston@caqh.org</span></span> <span>Fri, 06/24/2016 - 11:55</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>CAQH experienced a technical difficulty with our websites that has been resolved. However, some visitors may continue to experience difficulties accessing CAQH websites (including CAQH ProView and EnrollHub).</p> <h4>If you are having problems reaching CAQH sites today, please try the following:</h4> <ol><li>Clear out the network cache in the web browser you are using. Here is how:</li> </ol><ul style="margin-left: 40px;"><li><strong>In IE (Internet Explorer):</strong> Click on the gear in the upper right of your window, Select ‘Internet Options’ from the menu. In Internet Options, go down to Browsing History and click on ‘Delete…’. From there, select ‘Temporary Internet files and website files’ and ‘Cookies and website data’ and click ‘Delete’.</li> <li><strong>In Chrome:</strong> Select the three horizontal lines at the upper right and select ‘Settings’. Go down to ‘Privacy’ and select ‘Cookies and other site and plugin data’ and ‘Cached images and files’. Then select ‘Clear browsing data’.</li> </ul><p style="margin-left: 40px;">Note: You will need to log in to the sites again after doing this.</p> <p>      2.   If #1 does not resolve your problem, try using a Command prompt. Here is how: </p> <ul style="margin-left: 40px;"><li>Go to your Start menu.</li> <li>Either select Command window or type ‘cmd’ in the text box at the bottom.</li> <li>Enter the following command: <strong>ipconfig /flushdns</strong></li> <li>After typing that command, wait a few minutes and then try accessing the webpage again. </li> </ul><h4>For additional support, please contact the appropriate Support Center:</h4> <p style="margin-left: 40px;">Trouble accessing <strong>CAQH ProView</strong>: Call (888) 599-1771</p> <p style="margin-left: 40px;">Trouble accessing <strong>EnrollHub</strong>: Call (844) 815-9763 </p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/instructions" hreflang="en">Instructions</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-organization-type field--type-entity-reference field--label-inline"> <div class="field--label">Organization Type</div> <div class="field--item"><a href="/organization/healthcare-providers" hreflang="en">Healthcare providers</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Fri, 24 Jun 2016 15:55:04 +0000 mwoolston@caqh.org 1763 at https://www.caqh.org Press Kit https://www.caqh.org/about/press-kit <span>Press Kit</span> <span><span lang="" about="/users/mwoolstoncaqhorg" typeof="schema:Person" property="schema:name" datatype="">mwoolston@caqh.org</span></span> <span>Fri, 03/20/2015 - 14:11</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><h4>Media Inquiries</h4> <p>Members of the media, please contact:</p> <p><a href="mailto:mnew@caqh.org ">Maggie New</a><br /> Associate Brand Manager<br /> (202) 803-5985</p> <h4>Read CAQH News</h4> <p>Visit the News section for <a href="/about/press-releases">CAQH press releases</a>. Visit the Catalyst section for <a href="/about/newsletter-articles">CAQH articles</a>.</p> <h4>Overviews</h4> <p>Expand each section below for a brief description of CAQH, its solutions and initiatives.</p> <div class="accordion"> <h3>About CAQH<sup>®</sup> </h3> <div> <p>CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans.</p> <ul><li><strong>COB Smart<sup>®</sup></strong> quickly and accurately directs coordination of benefits processes.</li> <li><strong>EnrollHub</strong><strong><sup>®</sup></strong> reduces costly paper checks with enrollment for electronic payments and electronic remittance advice.</li> <li><strong>CAQH ProView</strong><strong><sup>®</sup></strong> eases the burden of provider data collection, maintenance and distribution.</li> <li><strong>SanctionsTrack<sup><span>®</span></sup></strong> delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions.</li> <li><strong>DirectAssure<strong><sup>® </sup></strong></strong>helps health plans increase the accuracy of provider directories.</li> <li><strong>VeriFide</strong><span><strong><span>TM</span></strong> </span> streamlines credentialing by consolidating and standardizing primary source verification.</li> <li><strong>CAQH CORE<sup><span>®</span></sup></strong> maximizes business efficiency and savings by developing and implementing federally mandated operating rules.</li> <li><strong>CAQH Index</strong><strong><sup>®</sup></strong> benchmarks progress and helps optimize operations by tracking industy adoption of electronic administrative transactions.</li> </ul></div> <h3>About CAQH CORE<sup>®</sup></h3> <div> <p>CAQH CORE is a nonprofit collaboration of over 130 public and private health plans, hospitals and health systems, vendors and other stakeholders across the industry. Through this collaboration, CAQH CORE helps stakeholders uniformly adopt electronic transactions and exchange data efficiently. Since 2005, CAQH CORE has developed and issued four phases of operating rules that support standards, accelerate interoperability and align administrative activities among providers, payers and consumers. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author of operating rules for HIPAA administrative healthcare transactions. In 2015, the CAQH CORE scope expanded to include exchange needs for value-based payment.</p> <p><a href="/sites/default/files/core/caqh-core-overview.pdf">CAQH CORE Fact Sheet</a></p> </div> <h3>About caqh solutions<sup>®</sup></h3> <div> <p>CAQH Solutions streamline the business of healthcare for health plans, providers, and other stakeholders. </p> <ul><li><strong>COB Smart<sup>®</sup></strong> quickly and accurately directs coordination of benefits processes.</li> <li><strong>EnrollHub™</strong> reduces costly paper checks with enrollment for electronic payments and electronic remittance advice.</li> <li><strong>CAQH ProView™</strong> eases the burden of provider data collection, maintenance and distribution.</li> <li><strong>SanctionsTrack<sup>®</sup></strong> delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions.</li> <li><strong>DirectAssure<strong><sup>® </sup></strong></strong>helps health plans increase the accuracy of provider directories.</li> <li><strong>VeriFide</strong><span><strong><span>TM</span></strong> </span> streamlines credentialing by consolidating and standardizing primary source verification.</li> </ul></div> <h3>About CAQH ProView<sup>®</sup>, A CAQH Solution<sup>®</sup></h3> <div> <p>CAQH ProView is a CAQH Solution and the trusted source and industry standard for collecting provider data used in credentialing, claims processing, quality assurance, emergency response, member services and more. By streamlining data collection electronically, CAQH ProView is reducing duplicative paperwork and millions of dollars of annual administrative costs for 1.4 million physicians and other health professionals, as well as more than 900 participating health plans, hospitals and healthcare organizations.</p> <p><a href="/sites/default/files/solutions/proview/CAQH_ProView_FINAL_4.7.15_final_0.pdf">CAQH ProView Fact Sheet</a></p> </div> <h3>About ENROLLHUB<sup>®</sup>, A CAQH SOLUTION<sup>®</sup></h3> <div> <p>EnrollHub is a CAQH Solution that combines enrollment capabilities for electronic funds transfer (EFT) and electronic remittance advice (ERA), enabling healthcare providers to use a single, secure on-line process to sign up for electronic payments with multiple health plans at once.</p> <p><a href="/sites/default/files/about/marketing/EnrollHub%20Fact%20Sheet%20FINAL%203-2015.pdf">EnrollHub Fact Sheet</a></p> </div> <h3>About COB Smart<sup>®</sup>, A CAQH Solution<sup>®</sup></h3> <div> <p>COB Smart is a CAQH Solution that improves the accuracy of coordination of benefits processes. Health plans directly contribute to a registry of coverage information that helps health plans and providers correctly identify which individuals have benefits that should be coordinated in order for corresponding claims to be processed correctly the first time.</p> <p><a class="ga-event" description="" gaevent="Binary Assets" href="/sites/default/files/solutions/cob-smart/cobsmart-overview.pdf" target="_blank" title="COB_Smart_Health Plans_brochure_4.3.15_final.pdf" type="application/pdf; length=506069">COB Smart Fact Sheet</a></p> <p> </p> <p> </p> </div> <h3>About DirectAssure<sup>®</sup>, A CAQH Solution<sup>®</sup></h3> <div> <p>DirectAssure is a fully-electronic CAQH Solution to improve the quality of provider data in health plan directories.</p> <p><a href="https://www.caqh.org/sites/default/files/solutions/fact-sheet-directassure.pdf">DirectAssure Fact Sheet</a></p> </div> <h3>ABOUT VERIFIDE™, A CAQH SOLUTION<sup>®</sup></h3> <div> <p>VeriFide is a primary source verification Solution that improves the quality, speed, and integrity of provider data provided to plans while reducing the overlapping, non-differentiating business processes associated with credentialing. CAQH is an NCQA-certified CVO.</p> <p><a href="https://www.caqh.org/sites/default/files/fact-sheet-verifide.pdf">VeriFide Fact Sheet</a></p> </div> <h3>About the CAQH Index<sup>®</sup></h3> <div> <p>The CAQH Index was created as an industry-wide resource for tracking the progress from a paper- and phone-based system to an electronically-enabled system. The CAQH Index helps healthcare industry stakeholders assess remaining gaps in this transition and develop strategies to optimize administrative processes.</p> <p><a href="https://www.caqh.org/explorations/caqh-index-report-0">Learn more about the CAQH Index</a>. </p> </div> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/instructions" hreflang="en">Instructions</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/press" hreflang="en">Press</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Fri, 20 Mar 2015 18:11:50 +0000 mwoolston@caqh.org 298 at https://www.caqh.org Contact https://www.caqh.org/about/contact <span>Contact</span> <span><span lang="" about="/users/mwoolstoncaqhorg" typeof="schema:Person" property="schema:name" datatype="">mwoolston@caqh.org</span></span> <span>Tue, 03/10/2015 - 19:17</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><h3>Healthcare Providers</h3> <h5> </h5> <h4>CAQH ProView<sup>®</sup> Support Desk:</h4> <p><strong>Live Chat </strong><em>:</em> <a href="https://proview.caqh.org/PR/">Log in to CAQH ProView</a> and <span>click the chat icon </span><img alt="CAQH ProView chat icon" title="CAQH ProView chat icon" style="height: 31px; width: 20px;" class="media-element file-default img-responsive" src="/sites/default/files/solutions/proview/resource/proview-chat-icon.jpg" typeof="foaf:Image" /><span> on any page: </span><br /><span>     Virtual chat support is available to answer most questions 24/7.<br />      Live chat agents are available Monday - Friday, 8:30 AM - 6:30 PM ET.</span></p> <p><strong>Phone</strong>: (888) 599-1771<br /><span>     Phone support is available Monday - Thursday, 7 AM - 9 PM ET and Friday, 7 AM - 7 PM ET.</span></p> <h4>Submit supporting documents for CAQH ProView:</h4> <p>Scanned copies of supporting documents should be submitted directly through <a href="https://proview.caqh.org">CAQH ProView</a>. From the “Documents" page on your data profile, you can upload a new document, replace an existing document, or delete a document. </p> <p>Documents mailed to CAQH headquarters in Washington, DC will NOT be processed. </p> <p> </p> <h4>EnrollHub<sup>®</sup> Support Desk [EFT and ERA enrollment]:</h4> <p>Email: <a href="mailto:efthelp@enrollhub.caqh.org">efthelp@EnrollHub.CAQH.org</a><br /> Phone: (844) 815-9763</p> <p> </p> <div class="accordion"> <h3>General Inquiries</h3> <div> <p>CAQH<br /> 2020 K Street, NW<br /> Suite 900<br /> Washington, DC 20006<br /> Phone: (202) 517-0400</p> <p><a href="mailto:info@caqh.org">info@caqh.org</a> </p> </div> <h3>SALES - ALL CAQH Solutions<sup>®</sup></h3> <div><a href="https://www.caqh.org/solutions/request-product-demo">Request</a> a CAQH Solution demo. </div> <h3>CAQH CORE<sup>®</sup></h3> <div> <p>For all questions about CAQH CORE or the CAQH CORE Operating Rules, please contact <a href="mailto:CORE@caqh.org">CORE@caqh.org</a>.</p> </div> <h3>CAQH Index<sup>®</sup></h3> <div> <p>Email: <a href="mailto:explorations@caqh.org?subject=CAQH%20Index">Explorations</a></p> </div> <h3>Media</h3> <div> <p>For all media inquiries, please contact <a href="mailto:mnew@caqh.org">Maggie New</a> or visit our online <a href="/about/press-kit">press room</a>.</p> </div> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/instructions" hreflang="en">Instructions</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Tue, 10 Mar 2015 23:17:08 +0000 mwoolston@caqh.org 156 at https://www.caqh.org CORE Certification Process https://www.caqh.org/core/core-certification-process <span>CORE Certification Process</span> <span><span lang="" about="/users/siteadmin" typeof="schema:Person" property="schema:name" datatype="">site_admin</span></span> <span>Thu, 02/26/2015 - 00:39</span> <div class="field field--name-field-subtitle field--type-text-long field--label-hidden field--item"><h2><h1><strong>CORE Certification: A Step-By-Step Process</strong></h1> </h2></div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><a name="Top" id="Top"></a></p> <h2>Overview</h2> <p>CAQH CORE certifies and awards CORE Certification Seals to <a href="https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/AreYouaCoveredEntity">entities </a>and products/services that create, transmit or use the administrative transactions addressed by the CAQH CORE Operating Rules. A CORE Certification Seal means an entity has demonstrated that its IT system or product is operating in conformance with CAQH CORE Operating Rules for specific transaction(s). CORE Certification is available for providers, health plans, clearinghouses, and vendor products. See a list of organizations that are currently undergoing or have completed CORE Certification <a href="http://www.caqh.org/core/core-certified-organizations-pending-and-current">HERE</a>.</p> <p>Are you an organization that wants to demonstrate its support for operating rules, but you do not create, transmit, or use administrative healthcare transactions? Find out how to become a CAQH CORE Endorser <a href="http://www.caqh.org/CORE_phase_1_endorsement.php">HERE</a>.</p> <p>CORE Certification on specific CAQH CORE Operating Rule transactions can be completed concurrently or successively. </p> <p>The CORE Certification process has five components:</p> <div class="bulletedlist"> <ol type="1"><li><a href="#Component 1">Pre-certification Planning and Systems Evaluation</a></li> <li><a href="#section2">Signing and Submitting the CORE Pledge</a></li> <li><a href="#section3">CORE Certification Testing</a></li> <li><a href="#section4">Applying for the CORE Seal</a></li> <li><a href="#Section5">Recertification</a></li> </ol></div> <p>Each of the components has multiple steps which must be completed prior to moving on to the next component. The CORE documents required to complete each component step are indicated and accessible through the included links to the CAQH website.</p> <p><em>Questions</em>: Contact CAQH CORE at <a href="mailto:core@caqh.org">core@caqh.org</a></p> <div class="embed"> </div> <div> <h2><a name="Component 1" id="Component 1">Component 1: Pre-certification Planning and Systems Evaluation</a></h2> <div>​Gauge your organization’s ability to adopt and become compliant with the CORE Operating Rules by identifying systems/software and business process gaps and start the collection of efficiency metrics to measure impact of operating rule implementation. The following documents will help you create a project plan to eliminate any gaps found between CAQH CORE rule requirements and your organization’s current capabilities: All gaps should be closed prior to the start of CORE certification testing.  Additionally, consider requesting a call with CAQH CORE Staff, who can provide guidance to help with your remediation project.<br />  </div> <div> <div class="bulletedlist"> <table align="left" border="1" cellpadding="0" cellspacing="0"><tbody><tr><td> <p><strong>Name of Document</strong></p> </td> <td> <p><strong>Description</strong></p> </td> <td> <p><strong>Eligibility &amp; Benefits</strong></p> </td> <td> <p><strong>Claim Status</strong></p> </td> <td> <p><strong>Payment &amp; Remittance</strong></p> </td> <td> <p><strong>PA &amp; Referrals</strong></p> </td> <td><strong>Health Care Claims</strong></td> <td> <p><strong>Benefit Enrollment</strong></p> </td> <td><strong>Premium Payment</strong></td> </tr><tr><td> <p><strong>CAQH CORE Operating Rules</strong></p> </td> <td> <p>Lists and explains the transaction-specific operating rules regarding Certification and Certification testing</p> </td> <td> <p align="center"><a href="https://www.caqh.org/core/eligibility-benefits-operating-rules"><strong>Eligibility &amp; Benefits</strong></a></p> </td> <td> <p align="center"><a href="https://www.caqh.org/core/claim-status-operating-rules"><strong>Claim Status</strong></a></p> </td> <td> <p align="center"><a href="https://www.caqh.org/core/payment-and-remittance-operating-rules"><strong>Payment &amp; Remittance</strong></a></p> </td> <td> <p><a href="https://www.caqh.org/core/prior-authorization-referrals-operating-rules"><strong>PA &amp; Referrals</strong></a></p> </td> <td><a href="https://www.caqh.org/core/health-care-claims-operating-rules"><strong>Health Care Claims</strong></a></td> <td> <p><a href="https://www.caqh.org/core/benefit-enrollment-operating-rules"><strong>Benefit Enrollment</strong></a></p> </td> <td><a href="https://www.caqh.org/core/premium-payment-operating-rules"><strong>Premium Payment</strong></a></td> </tr><tr><td> <p><strong>CAQH CORE Analysis and Planning Guides</strong></p> </td> <td> <p>Help entities identify system/software gaps and create a project plan to complete any necessary system remediation</p> </td> <td> <p><strong><a class="ga-event" description="" gaevent="Binary Assets" href="https://www.caqh.org/sites/default/files/core/CAQH_CORE_Eligibility_and_Benefits_Analysis_and_Planning_Guide.pdf?token=OQS04S4O" target="_blank" title="Phase I &amp; II Analysis &amp; Planning Guide" type="application/pdf; length=1256527">Eligibility &amp; Benefits Analysis &amp; Planning Guide</a></strong></p> </td> <td><strong><a class="ga-event" description="" gaevent="Binary Assets" href="https://www.caqh.org/sites/default/files/core/phase-ii/certification/caqh-core-analysis-planning-guide-pi-pii.pdf" target="_blank" title="Phase I &amp; II Analysis &amp; Planning Guide" type="application/pdf; length=1256527">Claim Status Analysis &amp; Planning Guide</a></strong></td> <td> <p><a href="https://www.caqh.org/sites/default/files/core/CAQH_CORE_Payment_and_Remittance_Analysis_and_Planning_Guide.pdf?token=pg0KTYL1"><strong>Payment &amp; Remittance<br /> Analysis &amp; Planning Guide</strong></a></p> </td> <td> <p><a href="https://www.caqh.org/sites/default/files/core/CAQH_CORE_Prior_Authorization_and_Referrals_Analysis_and_Planning_Guide.pdf?token=D12mT8hq"><strong>PA &amp; Referrals<br /> Analysis &amp; Planning Guide</strong></a></p> </td> <td><a href="https://www.caqh.org/sites/default/files/core/CAQH_CORE_Health_Care_Claims_Analysis_and_Planning_Guide.pdf?token=yHt3BshT"><strong>Health Care Claims<br /> Analysis &amp; Planning Guide</strong></a></td> <td> <p><a href="https://www.caqh.org/sites/default/files/core/CAQH_CORE_Benefit_Enrollment_Analysis_and_Planning_Guide.pdf?token=N6M-J01H"><strong>Benefit Enrollment<br /> Analysis &amp; Planning Guide</strong></a></p> </td> <td><a href="https://www.caqh.org/sites/default/files/core/CAQH_CORE_Premium_Payment_Analysis_and_Planning_Guide.pdf?token=3Jb5Eqhr"><strong>Premium Payment<br /> Analysis &amp; Planning Guide</strong></a></td> </tr><tr><td> <p><strong>CAQH CORE Master Test Suites</strong></p> </td> <td> <p>Transaction-specific documents that specify the test scripts that must be met in Certification Testing</p> </td> <td> <p align="center"><a href="https://www.caqh.org/sites/default/files/core/Eligibility-and-Benefits-Certification-Test-Suite-vEB1.0.pdf"><strong>Eligibility &amp; Benefits Master Test Suite</strong></a></p> </td> <td> <p align="center"><a href="https://www.caqh.org/sites/default/files/core/Claim-Status-Certification-Test-Suite-vCS1.0.pdf"><strong>Claim Status Master Test Suite</strong></a></p> </td> <td> <p align="center"><a href="https://www.caqh.org/sites/default/files/core/Payment-and-Remittance-Certification-Test-Suite-vPR1.0.pdf"><strong>Payment &amp; Remittance Master Test Suite</strong></a></p> </td> <td> <p><a href="https://www.caqh.org/sites/default/files/core/Prior-Authorization-and-Referrals-Certification-Test-Suite-vPA1.0.pdf"><strong>PA &amp; Referral Master Test Suite</strong></a></p> </td> <td><a href="https://www.caqh.org/sites/default/files/core/Health-Care-Claims-Certification-Test-Suite-vHC1.0.pdf"><strong>Health Care Claims Master Test Suite</strong></a></td> <td> <p><a href="https://www.caqh.org/sites/default/files/core/Benefit-Enrollment-Certification-Test-Suite-vBE1.0.pdf?token=P1cXw1Hg"><strong>Benefit Enrollment Master Test Suite</strong></a></p> </td> <td><a href="https://www.caqh.org/sites/default/files/core/Premium-Payment-Certification-Test-Suite-vPP1.0.pdf"><strong>Premium Payment Master Test Suite</strong></a></td> </tr><tr><td> <p><strong>Master Test Bed Data</strong></p> </td> <td> <p>Dummy data that must be used in Certification Testing</p> </td> <td> <p align="center"><strong><a href="https://www.caqh.org/sites/default/files/core/Eligibility-and-Benefits-Master-Test-Bed-Data.xls">Eligibility &amp; Benefits Master Test Bed Data</a></strong></p> </td> <td> <p align="center"><strong>Not<br /> Applicable</strong></p> </td> <td> <p><strong>Not<br /> Applicable</strong></p> </td> <td> <p><strong><a href="https://www.caqh.org/sites/default/files/core/Prior-Authorization-Master-Test-Bed-Data.xlsx">PA &amp; Referral Master Test Bed Data</a></strong></p> </td> <td><strong>Not Applicable</strong></td> <td> <p><strong>Not Applicable</strong></p> </td> <td><strong>Not Applicable</strong></td> </tr><tr><td><strong>CORE Certification Policy</strong></td> <td>Outlines principles and polices that guide the CORE Certification Program.</td> <td colspan="6"><strong>                                                      <a href="https://www.caqh.org/sites/default/files/core/CORECertificationPoliciesvCC1.0.pdf">CORE Certification Policy</a></strong></td> <td> </td> </tr><tr><td> <p><strong>CAQH CORE FAQs</strong></p> </td> <td> <p>Frequently asked questions and answers serve as helpful resources to organizations, aiding to answer both general and technical questions about CORE Certification and CAQH CORE Operating Rules</p> </td> <td colspan="6"> <p align="center"><a href="http://www.caqh.org/core/frequently-asked-questions"><strong>FAQS</strong></a></p> </td> <td> </td> </tr></tbody></table><p> </p> <p> </p> </div> </div> <h2><a name="section2" id="section2">Component 2: Sign and Submit the CORE Pledge</a></h2> <div> <ol type="A"><li>Sign and submit the CORE Pledge: The first form to submit is the CORE Pledge. The CORE Pledge must be signed by an authorized executive level employee.<br />  </li> <li>Submit the signed CORE Pledge for each of the CAQH CORE Operating Rule transactions that you are pursuing via email, fax, or mail.<br /><br /><strong>Email, Fax, or Postal Service Submission</strong>:<br /> Organizations may submit the CORE Pledge via email (<a href="mailto:CORE@caqh.org">CORE@caqh.org</a>), fax: (202) 517-0397 or mail: <br /><br /> CORE, c/o CAQH<br /> 2020 K Street, NW<br /> Suite 900<br /> Washington, DC 20006<br /><br /> Your organization may download and/or print the CORE Pledge Forms for the following transaction by clicking the accoiated links: <a href="https://www.caqh.org/sites/default/files/core/Eligibility-and-Benefits-CORE-Certification-Pledge.pdf">Eligibility &amp; Benefits</a>, <a href="https://www.caqh.org/sites/default/files/core/Claim-Status-CORE-Certification-Pledge.pdf">Claim Status</a>, <a href="https://www.caqh.org/sites/default/files/core/Payment-and-Remittance-CORE-Certification-Pledge.pdf">Payment &amp; Remittance</a>, <a href="https://www.caqh.org/sites/default/files/core/Prior-Authorization-and-Referrals-CORE-Certification-Pledge.pdf">PA &amp; Referral</a>, <a href="https://www.caqh.org/sites/default/files/core/Health-Care-Claims-CORE-Certification-Pledge.pdf">Health Care Claims</a>, <a href="https://www.caqh.org/sites/default/files/core/Benefit-Enrollment-CORE-Certification-Pledge.pdf">Benefit Enrollment</a> and/or <a href="https://www.caqh.org/sites/default/files/core/Premium-Payment-CORE-Certification-Pledge.pdf">Premium Payment</a>.</li> </ol><div class="embed"> </div> </div> <h2><a name="section3" id="section3">Component 3: CORE Certification Testing</a></h2> <div> <div class="embed">CORE Certification requires successful Certification Testing by a third-party CAQH CORE-authorized Testing Vendor. CAQH CORE-authorized Testing Vendors are chosen to conduct CORE Certification Testing for all of the CAQH CORE Operating Rules after a rigorous selection and approval process by CAQH CORE.</div> <div class="embed"><br /> Edifecs is currently the only CAQH CORE-authorized Testing Vendor; however, any organization that meets the requirements and completes review and approval by CAQH CORE is eligible to become a CAQH CORE-authorized Testing Vendor. </div> <p>Steps for CORE Certification Testing:</p> <ol><li>Register with <a href="https://www.edifecs.com/login/core-login" target="_blank">Edifecs</a>, a CAQH CORE-authorized Testing Vendor.</li> <li>Complete CORE Certification Testing within the 180-day pledge window.</li> <li>Contact the CAQH CORE-authorized Testing Vendor with any questions or concerns related to any part of the CORE Certification Testing process.</li> <li>Upon successful completion of the CORE Certification Testing, the CAQH CORE-authorized Testing Vendor will provide you with documentation that demonstrates the successful completion of your organization’s CORE Certification Testing. The CAQH CORE-authorized Testing Vendor will also provide a copy of your organization’s CORE Certification Testing to CAQH CORE. </li> </ol><p><strong>NOTE:</strong></p> <p>Any fee/cost imposed by the CAQH CORE-authorized Testing Vendor will be independent and separate from the fee charged by CAQH CORE for your organization to obtain the CORE Certification Seal.</p> <p>Complaints regarding CAQH CORE-authorized Testing Vendors: In the event an entity seeking CORE Certification is dissatisfied with its testing results, it may file an appeal with CAQH CORE. See the <a href="/sites/default/files/core/CORECertificationPoliciesvCC1.0.pdf" id="CORECertificationPolicy" name="CORECertificationPolicy" target="_blank">CORE Certification Testing Policy</a>.</p> <p> </p> </div> <h2><a name="section4" id="section4">Component 4: Applying For the CORE Seal</a></h2> <div> <div class="bulletedlist"> <p>After successful completion of CORE Certification Testing, your next step is to apply for the CORE Certification Seal. Applying for the CORE Certification Seal requires you to notify CAQH CORE that certification testing is complete, respond to CORE Certification Measurement Survey and to submit a CAQH CORE Seal Application, a CAQH CORE HIPAA Attestation, a CAQH CORE Certification Fee for each CAQH CORE Operating Rule transaction you are seeking to become CORE-certified.</p> <ol type="A"><li>Notify CAQH CORE that CORE Certification Testing with the CAQH CORE-authorized Testing Vendor has been completed. <br />  </li> <li> Respond to the CORE Certification Measurement Survey with submission of operating rule efficiency  metrics.<br />  </li> <li>Submit the CAQH CORE HIPAA Attestation and the CAQH CORE Seal Application for each CAQH CORE Operating Rule transaction that you are pursuing via email (<a href="mailto:CORE@caqh.org">CORE@caqh.org</a>) or mail:<br /><br /> CORE, c/o CAQH<br /> 2020 K Street, NW<br /> Suite 900<br /> Washington, DC 20006 <br /><br /> Your organization may download and/or print the forms via the following links:<br /><br /><a href="https://www.caqh.org/sites/default/files/core/forms/CAQH-CORE-Seal-Application%20(1).pdf">CORE Certification Seal Application</a><br /><br /> CAQH CORE HIPAA Attestation: <a href="https://www.caqh.org/sites/default/files/core/Eligibility-and-Benefit-HIPAA-Attestation.pdf">Eligibility &amp; Benefits</a>, <a href="https://www.caqh.org/sites/default/files/core/Claim-Status-HIPAA-Attestation.pdf">Claim Status</a>, <a href="https://www.caqh.org/sites/default/files/core/Payment-and-Remittance-HIPAA-Attestation.pdf">Payment &amp; Remittance</a>, <a href="https://www.caqh.org/sites/default/files/core/Prior-Authorization-and-Referrals-HIPAA-Attestation.pdf">PA &amp; Referrals</a>, <a href="https://www.caqh.org/sites/default/files/core/Health-Care-Claims-HIPAA-Attestation.pdf">Health Care Claims</a>, <a href="https://www.caqh.org/sites/default/files/core/Benefit-Enrollment-HIPAA-Attestation.pdf">Benefit Enrollment</a> or <a href="https://www.caqh.org/sites/default/files/core/Premium-Payment-HIPAA-Attestation.pdf">Premium Payment</a><br />  </li> <li>Determine your CORE Seal fee by reviewing the fee scale below.<br /><br /> The fee for the CORE Seal is based upon a stakeholder-specific fee scale. This fee is a one-time cost for each transaction of CORE certification, unless an entity becomes de-certified. For more information about certification and decertification, see the <a href="/sites/default/files/core/CORECertificationPoliciesvCC1.0.pdf" id="CORE Certification Policy" name="CORE Certification Policy" target="_blank">CORE Certification Policy</a><br /><br /><strong>Organizations pursuing more than one certification at a time are eligible for a discount. </strong>For more information on this savings opportunity, please email <a href="mailto:core@caqh.org">core@caqh.org</a></li> </ol><table align="center"><tbody><tr><th><strong>CORE SEAL FEE* SCALE</strong></th> <th> </th> </tr><tr><td><strong>Health Plans</strong></td> <td> </td> </tr><tr><td>Below $75 million in net annual revenue:</td> <td>$6,000 fee</td> </tr><tr><td>$75 million and above in net annual revenue:</td> <td>$9,000 fee</td> </tr><tr><td> </td> <td> </td> </tr><tr><td><strong>Clearinghouses</strong></td> <td> </td> </tr><tr><td>Below $75 million in net annual revenue:</td> <td>$6,000 fee</td> </tr><tr><td>     <i>EHNAC HNAP-EHN accredited</i></td> <td><i>- apply 10% ($600) discount</i></td> </tr><tr><td>$75 million and above in net annual revenue:</td> <td>$9,000 fee</td> </tr><tr><td>     <i>EHNAC HNAP-EHN accredited</i></td> <td><i>- apply 10% ($900) discount</i></td> </tr><tr><td> </td> <td> </td> </tr><tr><td><strong>Vendors</strong></td> <td> </td> </tr><tr><td>Below $75 million in net annual revenue:</td> <td>$6,000 fee</td> </tr><tr><td>$75 million and above in net annual revenue:</td> <td>$9,000 fee</td> </tr><tr><td> </td> <td> </td> </tr><tr><td><strong>Providers</strong></td> <td> </td> </tr><tr><td>Up to $1 billion in net annual revenue:</td> <td>$750 fee</td> </tr><tr><td>$1 billion and above in net annual revenue:</td> <td>$2,250 fee</td> </tr><tr><td> </td> <td> </td> </tr><tr><td><strong>Government</strong></td> <td> </td> </tr><tr><td>Federal or State Government Entities</td> <td>No Fee</td> </tr></tbody></table><p><br /><br /> Payment Options:</p> <ul><li>TO PAY BY ACH, contact CAQH CORE for an invoice. Send your CORE Seal Application form and HIPAA Attestation form to the address below. </li> <li>TO PAY BY PAPER CHECK, make your check payable to CAQH and send with your completed CORE Seal Application form and HIPAA Attestation form to:</li> </ul><blockquote> <p>CORE, c/o CAQH<br /> 2020 K Street, NW<br /> Suite 900<br /> Washington, DC 20006</p> </blockquote> </div> <ol start="4"><li>Upon receiving the CAQH CORE HIPAA Attestation and the CAQH CORE Seal Application, CAQH CORE conducts a robust, multi-level review of the application materials and the Certification Testing results. CAQH CORE will have a maximum of 20 business days to complete its assessment of the application and respond to the applicant with a clear response of approval or need for clarification.<br />  </li> <li>A final decision about the CAQH CORE Seal Application is made by CAQH CORE within 30 business days of receiving a complete application, unless there are extenuating circumstances. If so, CAQH CORE will notify the applicant about the reason for an extension to the review.<br />  </li> <li>After receiving a CORE Certification Seal:</li> </ol><ul><li>The certified entity may market itself as being CORE-certified.</li> <li>CAQH CORE will report on its website:<br />      - CORE-certified entities and endorser<br />      - The number of CORE Pledges it has received by stakeholder type​</li> </ul></div> </div> <h2><a name="Section5" id="Section5">Component 5: Recertification</a></h2> <p><span>Recertification ensures ongoing conformance of operating rules by CORE-certified organizations over time supporting market needs, evolving technology, mergers/acquisitions and system upgrades. </span></p> <p><strong><span>Guidelines for Recertification:</span></strong></p> <ul><li>Recertification is required every three years for an entity to remain CORE-certified. Recertification renewals may occur anytime during the calendar year, based off initial year of certification. </li> <li>After communicating intent to recertify, recertification testing must be completed within 180 days.</li> <li>CORE-certified entities will become decertified if there is a 180-day lapse in renewing certification.</li> <li>CORE-certified organizations must implement versions of the CAQH CORE Operating Rules that have been published 24 months prior to the CORE Certification Seal renewal date. </li> </ul><p><strong>Recertification - Step by Step Process:</strong></p> <ol><li><strong><span>Recertification Planning and Systems Evaluation</span></strong>​</li> </ol><ul><li>Your organization will need to evaluate for any changes or updates to operating rules, as most recent versions will have to be implemented. Execute any necessary system changes/updates as part of recertification. Begin the collection of efficiency metrics to measure impact of operating rule implementation.</li> </ul><ol start="2"><li><strong><span><strong>Apply for Recertification <em>(CORE Recertification Seal Application Form)</em></strong></span></strong></li> </ol><ul><li>Communicate intent to recertify and maintain certification status by completing the <a href="https://www.caqh.org/sites/default/files/core/forms/CAQH%20CORE%20Recertification%20Seal%20Application%20(2).pdf">CORE Recertification Seal Application Form</a>.</li> <li>Submit payment for recertification. <em>(Note: Fees for Recertification are ½ of the initial CORE Certification fee)</em></li> </ul><ol start="3"><li><b>Recertification Testing</b></li> </ol><ul><li>An entity undergoing recertification will need to work with a CORE-authorized testing vendor to perform certification testing based upon criteria outlined in the CAQH CORE Certification Test Suites.<b> </b><em>(Note: Recertification testing will have a reduced number of test cases and provide opportunitiy to recertify across multiple rule sets at once.)</em></li> </ul><ol start="4"><li><b>CORE Seal Renewal</b></li> </ol><ul><li>CAQH CORE will grant renewal of the CORE Certification Seal after an entity completes recertification testing, respond to the CORE Certification Measurement Survey, and submits all documentation required. For more information about recertification, see the <a href="https://www.caqh.org/sites/default/files/core/CAQH%20CORE%20Recertification%20Fact%20Sheet.pdf">CAQH CORE Recertification Fact Sheet</a>.</li> </ul><h2>CORE Certification Terms and Conditions</h2> <p>An entity’s CORE Certification Seal remains valid unless a certified entity’s seal is revoked as a result of a validated complaint of nonconformance. For more information on enforcement see the <a href="/sites/default/files/core/CORECertificationPoliciesvCC1.0.pdf" target="_blank">CAQH CORE Enforcement Polic</a>y.</p> <p>After remedying the issue which led to the validated complaint of noncompliance, the decertified entity is free to seek recertification at any time. Decertified entities will need to complete the entire certification process and pay all applicable fees to achieve CORE certification.</p> <p align="right"><a href="#Top">Return to Top</a></p> <div class="embed"><br />  </div> <div class="bulletedlist"> <p>​</p> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/instructions" hreflang="en">Instructions</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/core" hreflang="en">CORE</a></div> </div> Thu, 26 Feb 2015 05:39:18 +0000 site_admin 145 at https://www.caqh.org CORE Certification https://www.caqh.org/core/core-certification <span>CORE Certification</span> <span><span lang="" about="/users/siteadmin" typeof="schema:Person" property="schema:name" datatype="">site_admin</span></span> <span>Wed, 02/25/2015 - 06:05</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>CAQH awards CORE Certification Seals to entities that create, transmit or use the healthcare administrative and financial transactions addressed by the CAQH CORE Operating Rules. CORE Certification means an entity has demonstrated that its IT system or product, is operating in conformance with applicable requirements of a specific CAQH CORE Operating Rule.</p> <p><span style="color: rgb(68, 68, 68); font-family: &quot;Gotham Narrow SSm A&quot;, &quot;Gotham Narrow SSm B&quot;, &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px;">In December 2017, the Center for Medicare and Medicaid Services (CMS) launched an </span><a href="https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/EventsandLatestNews.html"><span style="color:0067b9;">administrative simplification pilot program</span></a><span style="color: rgb(68, 68, 68); font-family: &quot;Gotham Narrow SSm A&quot;, &quot;Gotham Narrow SSm B&quot;, &quot;Helvetica Neue&quot;, Helvetica, Arial, sans-serif; font-size: 15px;"> to ensure companies are complying with adopted standards and operating rules. Becoming CORE certified is the best way to document, test and confirm that you are in conformance with the operating rules and ready for CMS audits.</span></p> <p style="text-align: center;"><iframe align="middle" allowfullscreen="" frameborder="0" height="350" scrolling="no" src="https://www.youtube.com/embed/VeyvPZYhsOg" width="600"></iframe></p> <p><strong>If you are a health plan, provider, clearinghouse or vendor interested in information related to the CORE Certification please click </strong><a href="https://www.caqh.org/CORE_voluntary" target="_blank"><span style="color:0067b9;"><strong>HERE</strong></span></a><strong>.</strong></p> <p>Organizations that do not create, transmit or use healthcare administrative and financial transactions, and therefore are ineligible for CORE Certification, can demonstrate their support for the CAQH CORE mission and Operating Rules by applying for and using the CORE Endorser Seal. Please refer to the <a href="https://www.caqh.org/CORE_phase_1_endorsement.php" target="_blank"><span style="color:0067b9;">CORE Endorser Seal: Application Process</span></a> page for further information.</p> <div class="embed"> <div class="embed"> <div id="node-1509" class="node-embed-module clearfix"> <div class="clearfix"> <div class="course-image-left"><img src="/sites/default/files/core/core-medicaid-module-map-image.JPG" /></div> <div class="course-body-right"> <div class="title course-title"> <a href="http://tour.mapsalive.com/65537/page1.htm" target="_blank" title="CAQH CORE Medicaid Certification Dashboard">CAQH CORE Medicaid Certification Dashboard</a> </div> <div class="course-date">August 10, 2020</div> <div class="course-body"><p>Under revision.</p>&#13; </div> </div> </div> </div> </div> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/instructions" hreflang="en">Instructions</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/core" hreflang="en">CORE</a></div> </div> <div class="field field--name-field-card-video field--type-link field--label-above"> <div class="field--label">Card Video</div> <div class="field--item"><a href="https://www.youtube.com/embed/VeyvPZYhsOg">https://www.youtube.com/embed/VeyvPZYhsOg</a></div> </div> Wed, 25 Feb 2015 11:05:44 +0000 site_admin 134 at https://www.caqh.org Operating Rules Mandate https://www.caqh.org/core/operating-rules-mandate <span>Operating Rules Mandate</span> <span><span lang="" about="/users/siteadmin" typeof="schema:Person" property="schema:name" datatype="">site_admin</span></span> <span>Wed, 02/25/2015 - 03:31</span> <div class="field field--name-field-subtitle field--type-text-long field--label-hidden field--item"><h2><h1><strong>ACA Federal Mandate for Healthcare Operating Rules</strong></h1> </h2></div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>The <a href="http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html" target="_blank">Patient Protection and Affordable Care Act (ACA)</a>, Section 1104 “…establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs.” ACA Section 1104 requires the Secretary of the Department of Health and Human Services (HHS) to adopt and regularly update standards, implementation specifications, and operating rules for the electronic exchange and use of health information for the purposes of financial and administrative transactions. ACA Section 1104 applies to <a href="https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/AreYouaCoveredEntity">HIPAA covered entities</a> and business associates engaging in HIPAA standard transactions on behalf of covered entities. </p> <p>Operating rules are defined in the Affordable Care Act as the “necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications." Operating rules specify the information that must be included when conducting standard transactions covered under HIPAA, making it easier for providers to use electronic means to handle administrative transactions.</p> <p>View the <a href="https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html">CMS website</a> for more detail on the Administrative Simplification provisions of the ACA.</p> <p>Learn how CMS enforces Administrative Simplification requirements by watching this <a href="https://www.youtube.com/watch?v=-9EH2pAo0yQ">video</a>.</p> <h3>ACA Section 1104 Transactions Requiring Operating Rules</h3> <p>ACA Section 1104 required development of operating rules to address and support administrative transactions covered under HIPAA. CAQH CORE is designated by the Secretary of the Department of Health and Human Services (HHS) as the Operating Rule Authoring Entity for the HIPAA-mandated administrative transactions. </p> <table align="center"><thead><tr><th scope="row"> <center> </center> </th> <th scope="col"> <center>Eligibility &amp; Benefits,</center> <center>Claim Status</center> </th> <th scope="col"> <center>Payment &amp; Remittance</center> </th> <th scope="col"> <center>Other </center> <center>Transactions</center> </th> </tr></thead><tbody><tr><th scope="row"> <center><strong>Adoption Deadline</strong></center> </th> <td> <center>7/1/2011</center> </td> <td> <center>7/1/2012</center> </td> <td> <center>TBD</center> </td> </tr><tr><th scope="row"> <center><strong>Effective Date</strong></center> </th> <td> <center>1/1/2013</center> </td> <td> <center>1/1/2014</center> </td> <td> <center>TBD</center> </td> </tr><tr><th scope="row"> <p>CAQH CORE</p> <p>Operating Rules</p> </th> <td><a href="https://www.caqh.org/core/eligibility-benefits-operating-rules">Eligibility &amp; Benefits</a> and <a href="https://www.caqh.org/core/claim-status-operating-rules">Claim Status</a></td> <td><a href="https://www.caqh.org/core/payment-and-remittance-operating-rules">Payment &amp; Remittance</a></td> <td> </td> </tr></tbody></table><h3>Phases to Business Transactions Naming Conventions: Currently Adopted Operating Rules</h3> <p>In May 2020 CAQH CORE updated its phase-based operating rule structure to align with the business processes supported by the rules. Therefore, rather than five phases of operating rules spanning seven transactions, under the new structure there are seven sets of operating rules organized by healthcare business processes. This change aligns with current stakeholder operations, enhances flexibility to update requirements, enables more rapid and targeted rule development efforts, and eliminates the potential for an infinite number of future operating rule phases. As a result of this transition, the CAQH CORE Operating Rule naming and versioning conventions were updated. No substantive changes were made to the operating rules requirements. Therefore, conformance with the updated operating rules will result in conformance with the federally mandated operating rule requirements. CAQH CORE has provided links to the federally mandated versions of the operating rules for reference below along with a crosswalk to the new naming and versioning conventions. Click <span><span><strong><a href="https://www.caqh.org/core/new-operating-rule-structure">here</a></strong> </span></span>for more information on the new operating rules structure.</p> <div> <div> <div class="msocomtxt" id="_com_2" language="JavaScript"> <table align="center" class="MsoTableGrid"><thead><tr><td> <p align="center"><span><span><span><b><span><span>Former Operating Rule Name</span></span></b></span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span><b><span><span>Former Version</span></span></b></span></span></span></p> </td> <td> <p align="center"><span><span><span><b><span><span>Current Operating Rule Name</span></span></b></span></span></span></p> </td> <td> <p align="center"><span><span><span><b><span><span>Current Version</span></span></b></span></span></span></p> </td> </tr></thead><tbody><tr><td colspan="4" valign="top"> <p align="center"><span><span><span><span>CAQH CORE ELIGIBILITY &amp; BENEFITS (EB) OPERATING RULE SET</span></span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf7s/339361/1604088257Hw6eNpZJ/Phase_I.152.Real_Time_Companion_Guide.pdf"><span><span><span>Phase I CORE 152: Eligibility and Benefit Real Time Companion Guide Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v1.1.0</span></span></span></p> </td> <td rowspan="4" valign="top"> <p><span><span><span>CAQH CORE Eligibility &amp; Benefits (270/271) Infrastructure Rule</span></span></span></p> <p> </p> <p><span><span><span><i>All eligibility infrastructure requirements combined into a single infrastructure rule. </i></span></span></span></p> </td> <td rowspan="4" valign="top"> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"> </p> <p align="center"><span><span><span>vEB.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9z/339361/1604088341aLusaGaF/Phase_I.155.Batch_Response_Time_Rule.pdf"><span><span><span>Phase I CORE 155: Eligibility and Benefits Batch Response Time Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v1.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9x/339361/1604088341s53hdzzJ/Phase_I.156.Real_Time_Response_Time_Rule.pdf"><span><span><span>Phase I CORE 156: Eligibility and Benefits Real Time Response Time Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v1.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9s/339361/1604088341v8UeAQw2/Phase_I.157.System_Availability_Rule.pdf"><span><span><span>Phase I CORE 157: Eligibility and Benefits System Availability Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v1.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxfb2/339361/1604088341uIzHgsfn/Phase_I.154.270.271.Data_Content_Rule.pdf"><span><span><span>Phase I CORE 154: Eligibility and Benefits 270/271 Data Content Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v1.1.0</span></span></span></p> </td> <td rowspan="4" valign="top"> <p><span><span><span>CAQH CORE Eligibility &amp; Benefits (270/271) Data Content Rule</span></span></span></p> <p> </p> <p><span><span><span><i>All eligibility data content requirements combined into a single data content rule.</i></span></span></span></p> </td> <td rowspan="4" valign="top"> <p align="center"><span><span><span>vEB.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9n/339361/1604088341JBwg4T9E/Phase_II.260.Data_Content_Rule.pdf"><span><span><span>Phase II CAQH CORE 260: Eligibility &amp; Benefits Data Content (270/271) Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v2.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9v/339361/1604088341N7iKhRtL/Phase_II.258.270.271.Normalizing_Patient_Last_Name_Rule.pdf"><span><span><span>Phase II CAQH CORE 258: Eligibility and Benefits 270/271 Normalizing Patient Last Name Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v2.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9q/339361/1604088341F2Jomw13/Phase_II.259.270.270.AAA_Error_Code_Reporting_Rule.pdf"><span><span><span>Phase II CAQH CORE 259: Eligibility and Benefits 270/271 AAA Error Code Reporting Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v2.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxfb4/339361/1604088342OiJebuY6/Phase_I.153.Connectivity_Rule.pdf"><span><span><span>Phase I CORE 153: Eligibility and Benefits Connectivity Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span><span>v1.1.0</span></span></span></span></p> </td> <td valign="top"> <p><span><span><span><span>CAQH CORE Connectivity Rule</span></span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vC1.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxffz/339361/16040887364HA8elsD/Phase_II.270.Connectivity_Rule.pdf"><span><span><span>Phase II CAQH CORE 270: Connectivity Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v2.2.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Connectivity Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vC2.2.0</span></span></span></p> </td> </tr><tr><td colspan="4" valign="top"> <p align="center"><span><span><span><span>CAQH CORE CLAIM STATUS (CS) OPERATING RULE SET</span></span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9l/339361/1604088340TRcv83jF/Phase_II.250.Claim_Status_Rule.pdf"><span><span><span>Phase II CAQH CORE 250: Claim Status Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v2.1.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Claim Status (276/277) Infrastructure Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vCS.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxffz/339361/16040887364HA8elsD/Phase_II.270.Connectivity_Rule.pdf"><span><span><span>Phase II CAQH CORE 270: Connectivity Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v2.2.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Connectivity Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vC2.2.0</span></span></span></p> </td> </tr><tr><td colspan="4" valign="top"> <p align="center"><span><span><span><span>CAQH CORE PAYMENT &amp; REMITTANCE (PR) OPERATING RULE SET</span></span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9j/339361/16040883406Zcf1M2A/Phase_III.350.Health_Care_Claim_Payment.Advice835.Infrastructure_Rule.pdf"><span><span><span>Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v3.0.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Payment &amp; Remittance (835) Infrastructure Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vPR.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9g/339361/1604088340YzJLW9h8/Phase_III.360.Uniform_Use_of_Claim_Adjustment_Reason_Codes_and_Remitta.pdf"><span><span><span>Phase III CORE 360 Uniform Use of Claim Adjustment Reason Codes and Remittance Advice Remark Codes (835) Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v3.0.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Payment &amp; Remittance (835) Uniform Use of CARCs and RARCs Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vPR.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9d/339361/16040883403N0igYkq/Phase_III.370.EFTandERA_Reassociation.Rule_Version.pdf"><span><span><span>Phase III CORE 370 EFT &amp; ERA Reassociation (CCD+/835) Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v3.0.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Payment &amp; Remittance (CCD+/835) Reassociation Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vPR.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf9b/339361/1604088340Sdcz2RUp/Phase_III.380.EFT_Enrollment_Data_Rule.pdf"><span><span><span>Phase III CORE 380 EFT Enrollment Data Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v3.0.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Payment &amp; Remittance EFT Enrollment Data Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vPR.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxf98/339361/1604088340QPOgYb7d/Phase_III.382.ERA_Enrollment_Data_Rule.pdf"><span><span><span>Phase III CORE 382 ERA Enrollment Data Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v3.0.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Payment &amp; Remittance ERA Enrollment Data Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vPR.1.0</span></span></span></p> </td> </tr><tr><td valign="top"> <p><a href="https://go.caqh.org/l/339361/2020-10-30/2bxffz/339361/16040887364HA8elsD/Phase_II.270.Connectivity_Rule.pdf"><span><span><span>Phase II CAQH CORE 270: Connectivity Rule</span></span></span></a></p> </td> <td valign="top"> <p align="center"><span><span><span>v2.2.0</span></span></span></p> </td> <td valign="top"> <p><span><span><span>CAQH CORE Connectivity Rule</span></span></span></p> </td> <td valign="top"> <p align="center"><span><span><span>vC2.2.0</span></span></span></p> </td> </tr></tbody></table></div> </div> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/instructions" hreflang="en">Instructions</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/core" hreflang="en">CORE</a></div> </div> Wed, 25 Feb 2015 08:31:48 +0000 site_admin 126 at https://www.caqh.org