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The Implementation Deadline for Federally-mandated CAQH CORE EFT and ERA Operating Rules was January 1, 2014.
Learn more about CAQH CORE resources available to help your organization meet the Patient Protection and Affordable Care Act's operating rule mandate.


CORE Overview Presentation


CORE Provider Presentation

CORE Phase III Rules

The Complete Set of Phase III CAQH CORE EFT & ERA Operating Rules, developed by CORE Participants with industry input, was approved in the final CORE vote in June 2012 as the final step in the CORE voting process. On August 10,2012, HHS issued an Interim Final Rule with Comment (IFC) adopting the complete Phase III CAQH CORE EFT & ERA Operating Rules, including the CORE v5010 Master Companion Guide Template, to fulfill the ACA Section 1104 Federal mandate for national EFT & ERA Operating Rules. Covered entities must be in compliance with the EFT & ERA Operating Rule Set by January 1, 2014. In April 2013, CMS issued a notice adopting CMS-0028-IFC as a Final Rule. Industry implementation efforts should be well underway for the January 1, 2014 effective date for implementation of the Federally mandated CAQH CORE EFT & ERA Operating Rules. This notice also urged stakeholders to get involved in the CAQH CORE Code Combinations Maintenance Process.

NOTE: The Final Rule does not adopt the Batch Acknowledgement Requirements in Section 4.2 of CAQH CORE Rule 350, as the Secretary has not yet adopted HIPAA-standards for acknowledgements. Additionally, CORE Certification is and remains voluntary.

Phase III CAQH CORE Policies (300-305)

CAQH CORE 300: Guiding Principles

CAQH CORE 301: Pledge

CAQH CORE 302: Certification Policy

CAQH CORE 303: Exemption Policy

CAQH CORE 304: Testing Policy

CAQH CORE 305: Enforcement Policy

Phase III CAQH CORE EFT & ERA Operating Rules

Per the CORE Rules Development Process, for each CAQH CORE Rule Set a Voluntary CORE Certification Test Suite is developed specifying how entities can achieve voluntary CORE Certification with the rule set. The Phase III CORE EFT & ERA Operating Rules Voluntary Certification Test Suite was also approved in the final CORE vote in June 2012 and Voluntary CORE Certification is now available to interested entities. Please contact CORE@caqh.org if your entity is interested in becoming an early adopter for this rule set.

Other CAQH CORE Rules

ACA-Related

  • The Phase I and Phase II CAQH CORE Eligibility and Claim Status Operating Rules are already mandated by the ACA with an implementation deadline of January 1, 2013 - see here for details.
  • CAQH CORE is in the process of drafting additional rules to respond to the third and final set of operating rules required by the ACA. If you are interested in learning more or participating, email CORE@caqh.org.

Voluntary

  • CAQH CORE has also developed other operating rules that are currently voluntary. If you are interested in learning more or obtaining a copy of these draft rules, email CORE@caqh.org.