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CAQH ProView® is the trusted electronic solution and industry standard for capturing and sharing healthcare provider self-reported information.
Today, more than 1.6 million physicians and other providers enter and maintain a wide range of information within CAQH ProView.
Drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers and consumers.
An industry-wide facilitator of a trusted, simple and sustainable healthcare data exchange that evolves and aligns with market needs.
The CAQH CORE Payment & Remittance Operating Rule Set addresses a range of operating rule requirements for the HIPAA-mandated EFT and ERA transactions including streamlining provider enrollment, EFT and ERA reassociation, infrastructure, and consistent use of claim adjustment and denial codes.
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.
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.
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
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.
| 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 |
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