EDI CAQH CORE 153 Testing

EDI CAQH CORE 153 Testing Processing FAQs

EDI CAQH CORE 153 Testing FAQs are provided for new CAQH CORE trading partners passing EDI implementation phase. EDI CAQH CORE 153 Testing should be used together with other EDI CAQH CORE 153 Testing rules described in the previous posts.
1.For the purposes of the re-transmission, what is the definition of a duplicate transaction?

CAQH CORE does not define a duplicate transmission. Please refer to your own internal policies.

2. What happens if a provider’s system continues to send duplicate transactions within 15 minutes?

CAQH CORE does not define the recourse for information sources in this case.

3. Is there a retention time period required by the CAQH CORE 153 Rule for how long the source needs to maintain this transaction tracking information?

CAQH CORE recognizes that every organization has its own record-retention policies and does not mandate a strict requirement for retention of tracking information. To support ongoing tracking of response times and performance measurement, CAQH CORE recommends that entities keep this information for at least 18 months, if that is in accord with the organization’s existing policies.

4. Can my vendor offer HTTP/S on my behalf?

The Phase I CAQH CORE Operating Rules do not require that an entity (provider or health plan) implement the technology directly into their own data center. The Phase I CAQH CORE Rules implicitly acknowledge that both providers and health plans will use technology solutions provided by vendors to accomplish all that must be done. Neither do CAQH CORE Operating Rules require a “direct” connect – meaning that providers connect directly to the health plan’s data center and do not connect to any intermediary, such as a clearinghouse. Thus, the Phase I CAQH CORE Rules do not require any specific architecture. Rather, CAQH CORE Operating Rules specify the capabilities that need to be enabled by any CORE-certified entity.

An entity seeking CORE Certification, working with or without their vendor providing the HTTP/S connectivity capability, will have to demonstrate conformance with the Phase I CAQH CORE Connectivity Rule through the CORE Certification testing.

CAQH CORE encourages payers who are using vendors to review their compliance to make sure that they are fully in compliance with both CAQH CORE and HIPAA, particularly the clause in HIPAA that says payers cannot charge more than the cost of telecommunications for handling the connectivity.

5. What is the payload identifier (ID)?

Within the context of the CAQH CORE Connectivity Rule the payload ID is an identifier that uniquely identifies the X12 interchange(s) transported by the HTTP message and is used to allow submitters and information receivers to easily reconcile their records of submissions and responses. CAQH CORE elected to use an ID outside of the X12 message for this purpose because many information receivers’ systems separate the HTTP communication processing from the X12 message processing. The payload ID is generated and sent by the entity that initiates the HTTP communication session.

Usually this is the provider or clearinghouse that is sending the request to the health plan or other information source. It is one of the CAQH CORE-required HTTP message parameters (along with authorization information and date and time stamps) and it must be unique to each HTTP message and the X12 interchange(s) being transported by the HTTP message instance. All CORE-certified entities are required to capture, log and be able to report on each HTTP message transporting an X12 interchange and to be able to link the X12 interchange to a specific HTTP message instance. The payload ID (Message Body identifier) is the mechanism used to associate a given instance of an X12 interchange to the HTTP message instance.

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