FAQs: Learn More about CAQH CORE

CAQH CORE has developed a series of FAQs to address common questions about:

• General CAQH CORE
• These FAQs address CAQH CORE’s background and mission, the CAQH CORE Rules Development Process, and procedures and policies related to CORE Participation, Voluntary CORE Certification, and CORE Endorsement.
• ACA Section 1104 Mandate for Federal Operating Rules
• These FAQs address HHS adoption status of the ACA-mandated operating rules and ACA Federal compliance requirements.
• NOTE: The CMS Office of E-Health Standards & Services (OESS) is the authority on the HIPAA and ACA Administrative Simplification provisions; more detailed information on the provisions, as well as compliance and enforcement requirements, is available on the CMS website and via the CMS FAQs.
• CAQH CORE Eligibility & Claim Status Operating Rules
• These FAQs address technical rule requirements and stakeholder specific implementation for the first set of ACA-mandated operating rules.
• CAQH CORE EFT & ERA Operating Rules
• These FAQs address technical rule requirements and stakeholder specific implementation for the second set of ACA-mandated operating rules.
• CAQH CORE Operating Rules in Development
• These FAQs address upcoming CAQH CORE rules development to address the ACA Section 1104 mandated and voluntary CAQH CORE Operating Rules in development.

The FAQs will be updated as appropriate and to share lessons learned. NOTE: No adjustments to CAQH CORE rule requirements will be made via the FAQ process.

Additional CAQH CORE resources are available to assist with implementation of the ACA-mandated CAQH CORE Eligibility & Claim Status Operating Rules and CAQH CORE EFT & ERA Operating Rules:  See Operating Rules Mandate – Eligibility and Claims Status and Operating Rules Mandate – EFT & ERA.

If you have any additional questions not addressed by the CAQH CORE Online Resources, please email CORE@caqh.org.

CAQH CORE FAQs: Table of Contents

FAQs Part A: General CAQH CORE
I. Overview of CAQH CORE
II. Introduction to CORE Participation
III. Introduction to CORE Endorsement and Voluntary CORE Certification
IV. Voluntary CORE Certification Policies
V. CAQH CORE Measures of Success
VI. CAQH CORE Resources and Links

FAQs Part B: ACA Section 1104 Federal Mandate
I. Overview: ACA Section 1104 Provisions for Federal Operating Rules
II. Requirements for Federal Operating Rules Addressing the Eligibility & Claim Status Transactions
III. Requirements for Federal Operating Rules Addressing the EFT & ERA Transactions

FAQs Part C: CAQH CORE Eligibility & Claim Status Operating Rules
I. Overview of CAQH CORE Eligibility & Claim Status Operating Rules
II. Interdependent CAQH CORE Eligibility & Claim Status Requirements
III. CAQH CORE 150: Batch Acknowledgements Rule
IV. CAQH CORE 151: Real Time Acknowledgements Rule
V. CAQH CORE 152: Companion Guide Rule
VI. CAQH CORE 153: Connectivity Rule
VII. CAQH CORE 154: 270/271 Data Content Rule
VIII. CAQH CORE 155: Batch Response Time Rule
IX. CAQH CORE 156: Real Time Response Time Rule
X. CAQH CORE 157: System Availability Rule
XI. CAQH CORE 250: Claim Status Infrastructure Rule
XII. CAQH CORE 258: Normalizing Patient Last Name Rule
XIII. CAQH CORE 259: AAA Error Code Reporting Rule
XIV. CAQH CORE 260: Data Content (270/271) Rule
XV. CAQH CORE 270: Connectivity Rule
XVI. Resources for Implementing the CAQH CORE Eligibility & Claim Status Operating Rules
XVII. Voluntary Phase I & Phase II CORE Certification

FAQs Part D: CAQH CORE EFT & ERA Operating Rules
I. Overview of CAQH CORE EFT & ERA Operating Rules
II. Interdependent CAQH CORE EFT & ERA Requirements
III. CAQH CORE 350: Health Care Claim Payment/Advice (835) Infrastructure Rule
III. CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rule
IV. CAQH CORE 370: EFT & ERA Reassociation (CCD+/835) Rule
V. CAQH CORE 380: EFT Enrollment Data Rule
VI. CAQH CORE 382: ERA Enrollment Data Rule
VII. Resources for Implementing the CAQH CORE EFT & ERA Operating Rules

FAQs Part E: CAQH CORE Operating Rules in Development
I. Development of Remaining ACA-mandated Operating Rules
II. Development of Voluntary Operating Rules