Federal Adoption Update for CORE Operating Rules

Overview

CAQH CORE is designated by the Secretary of the Department of Health and Human Services (HHS) as the National Operating Rule Authoring Entity for the administrative transactions covered by HIPAA. Two sets of CORE Operating Rules are currently moving through the federal mandate process. This process began when the CORE Board submitted recommendations to the National Committee for Vital and Health Statistics (NCVHS), an advisor to the Secretary of the Department of Health and Human Services (HHS), supporting federal adoption of these rules.

The updated and new operating rules developed by CORE Participants enhance interoperability and streamline workflows by reducing manual approaches to modern business needs.

The two sets of CORE Operating Rules are at different stages on the federal adoption pathway. One set, already recommended by NCVHS for federal adoption, is awaiting an Interim Final Rule (IFR) from HHS. Once the IFR is published, industry will have 25 months to conform with new and updated CORE Operating Rule Requirements. The second set of CORE Operating Rules is awaiting consideration and recommendation.