CAQH CORE 250: Claim Status Infrastructure Rule Guides

CAQH CORE 250 Rule for operating rules for the eligibility and claim status transactions adopts all the Phase I and II CAQH CORE Eligibility and Claim Status Operating Rules except those requirements pertaining to the use of Acknowledgements. Entities seeking CORE Certification must implement all of the CAQH CORE Eligibility and Claim Status Operating Rules applicable to their stakeholder type, including those rules & rule requirements pertaining to use of Acknowledgments.

An entity that processes X12 270/271 eligibility transactions, and does not process claim status transactions can become Phase II CORE-certified, that is the Phase II CAQH CORE Operating Rules do not require an organization to conduct, use or process the X12 276/277 claim status transactions if it does not currently do so.

As a Phase II CORE-certified entity, you are not required to apply the Phase II CAQH CORE Patient Identifiers Rules to the conduct of the claim status transactions as it is specific to the conduct of eligibility/benefits transactions. An entity implementing the X12 276/277 transactions is required to support CAQH CORE Connectivity 270 v 2.2.0 as specified in the CAQH CORE 250 Rule, Section 4.1.

How did CAQH CORE decide that HTTP/S is secure and reliable enough to protect the delivery of healthcare information over the Internet? In Phase I development discussions, CAQH CORE solicited input on this topic from its Technical Work Group members and experts within healthcare and other industries, such as financial services. Based on this input, including the information that other healthcare industry projects, such as the Markle Foundation’s Connecting for Health project and the CMS Nationwide Health Information Network architecture prototypes, are using HTTP/S over the Internet, CAQH CORE determined that HTTP/S is an appropriate choice as the baseline standard for delivery of healthcare information. Payers must support HTTPS 1.1 in order to achieve CORE Certification. The intent of CAQH CORE 270: Connectivity Rule Version 2.2.0, which applies to the conduct of this Phase II CAQH CORE Claim Status Rule, is to provide a safe harbor that application vendors can develop towards without needing to get detailed information from every potential payer with whom they would like to connect.

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