CAQH CORE Eligibility & Claim Status Batch Acknowledgements Guidelines
CAQH CORE Eligibility & Claim Status Batch Acknowledgements guidelines require that the health plan or information receiver must always return an ASC X12 Implementation Acknowledgement (999) for all functional groups, whether or not the group is rejected. This requirement allows the provider to know within a reasonable timeframe if the submitted batch of inquiries was accepted by the health plan and will be processed. Likewise, the rule also requires that the provider must always return an ASC X12 Implementation Acknowledgement (999) Functional Acknowledgement for all functional groups whether or not the group is rejected, thereby allowing timely resolution of any issues.
CAQH CORE Eligibility & Claim Status Batch Acknowledgements rules address only the ASC X12 Implementation Acknowledgement (999); therefore your organization’s system must be able to return an ASC X12 Implementation Acknowledgement (999) for all functional groups. If it is unable to do so, your organization will need to remediate the system to be in conformance with the CAQH CORE Rule in order to become CORE-certified.
Your organization must successfully complete all of the required certification test scripts required by the Phase I CAQH CORE Certification Test Suite to become CORE-certified. The test scripts for the CAQH CORE 150: Batch Acknowledgements Rule Version 1.1.0will test for your system’s capabilities to return the ASC X12 Implementation Acknowledgement (999).
The CAQH CORE Batch and Real Time Acknowledgement Rules do not address the use of the ASC X12 Interchange Acknowledgement TA1.
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.