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)
Phase III CAQH CORE EFT & ERA Operating Rules
- CAQH CORE 350: Health Care Claim Payment/Advice (835) Infrastructure Rule
- CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rule
- CORE-required Code Combinations for CORE-defined Business Scenarios for CAQH CORE 360 Rule v3.0.4 February 2014
- New Resource from CAQH CORE: For more information about the CAQH CORE Code Combinations Maintenance Process, please visit the Ongoing Maintenance of the CORE Code Combinations for CAQH CORE 360 Rule Webpage. The purpose of this webpage is to serve as a "one stop shop" for all the necessary tools and information to comply with CAQH CORE 360 Rule and the ongoing maintenance process. Highlights from the new webpage include:
- Access to current and past versions of the CORE Code Combinations
- Timeline for updates and compliance
- Instructions related to the Market-based Review process
- Key considerations by stakeholder type
- CAQH CORE 370: EFT & ERA Reassociation (CCD+/835) Rule
- CAQH CORE 380: EFT Enrollment Data Rule
- CAQH CORE 382: ERA Enrollment Data Rule
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
- 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.
- 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.