CAQH CORE 156: Real Time Response Time Rule Basic Guidelines

CAQH CORE 156: Real Time Response Time Rule indicates that the number of responses returned within the specified timeframe gives a better indication of the information source’s capabilities. Averages can be skewed by outlier responses.

Providers do not have to be certified by CAQH CORE to interact with CORE-certified payers under the CAQH CORE Rules.

The 20-second requirement described in the CAQH CORE 156: Real Time Response Time Rule and 250 Rule is the duration for the entire round-trip of the transaction. The 20 seconds begin when the X12 270 Inquiry or X12 276 Request is first submitted, and ends when the X12 271 Response or X12 277 Response is delivered to the provider. All ensuing hops are included in these 20 seconds. Conformance with the rule is determined when 90 percent of all required responses are returned within the specified maximum response time as measured within a calendar month. Each HIPAA-covered entity is required to conform to the Federally mandated CAQH CORE Eligibility & Claim Status Operating Rules. Each HIPAA covered entity within the transaction flow is bound by the CAQH CORE Rule requirements for meeting the 20-second round trip of the transaction (CAQH CORE recommends no more than 4 seconds per hop).

What happens when a real time response is not received within the required 20-second window?

The CAQH CORE 270: Connectivity Rule requires that the connection remain open for 60 seconds to accommodate any potentially delayed responses. In the event that a specific real time response message is not received within the 20-second window, the requirements described in CAQH CORE 270 Rule (Section 4.3.6, Response, Timeout and Retransmission Requirements) would apply.

NOTE: The CAQH CORE 156: Real Time Response Time Rule and 250 Rule require that 90 percent of all X12 271 and X12 277 responses be returned within the 20-second maximum response time within a calendar month to be in conformance with the rule requirements.

Leave a Reply

Your email address will not be published.

Post Navigation