Description

Landing page that describes or introduces a solution or initiative

Claim Status Operating Rules

The CAQH CORE Claim Status Operating Rules enhance the exchange of claim status information between health plans and provider through consistent infrastructure including requirements that allow providers to check the status of a claim electronically, without manual intervention, or confirm claims receipt.

Ongoing Maintenance of the EFT & ERA Enrollment Data Sets

Status of the EFT & ERA Data Sets Maintenance Process: 2020 Limited Review Complete. Next Comprehensive Review scheduled for Q4 2021

 

Keeping Up with the CORE-required Maximum Enrollment Data Sets

If you are tasked with implementing the EFT & ERA Enrollment Data Rules, part of the Affordable Care Act (ACA)-mandated CAQH CORE Payment & Remittance Operating Rules, you will find all the necessary tools and information here to comply with these operating rules.

About CAQH

For more than 20 years, CAQH has created shared initiatives to streamline healthcare administration. Today, CAQH technology-enabled solutions, operating rules and research help nearly 1,000 health plans,1.6 million providers, government entities and vendors connect, exchange information and operate more efficiently.

Solutions

Metrics

A CAQH study, conducted by IBM Global Business Services, assessed results achieved by six CORE-certified health plans that represent 33 million covered lives (Aetna, AultCare, BlueCross BlueShield of North Carolina, BlueCross BlueShield of Tennessee, Health Net, and WellPoint affiliated health plans), as well as leading provider groups and vendors using the Phase I CAQH CORE Operating Rules. The study analyzed data from the three-month period prior to health plan certification and one year later.

Voting Process

CAQH CORE Body* CAQH CORE Requirements for Rules Approval

Level 1:

CAQH CORE Subgroups

Not addressed in governing procedures, but must occur to ensure consensus building.

Level 2:

CAQH CORE Work Groups