EDI HTTP Guidelines For CAQH CORE 250: Claim Status Infrastructure Rule

EDI HTTP guidelines refer to parties contracting with Medicare and CAQH CORE-authorized testing vendors. One of the typical questions from vendors – “Is there a required format in Phase I CAQH CORE Connectivity for the authorization, date/time, and payload ID to be sent in the HTTP message?”. CAQH CORE decided not to require a format for these data elements for Phase I. However, in Phase II CAQH CORE and future phases, CAQH CORE does require a specific format for sending these data elements. Contracting parties should speak with their CAQH CORE-authorized testing vendor on how they will work with on CORE Certification testing given the organization’s current HTTP format requirements and those used by the CAQH CORE-authorized testing vendor.
The conformance guidelines for different stakeholder types for implementing the two envelope standards (SOAP 1.2 and HTTP+MIME Multipart) defined in CAQH CORE 270: Connectivity Rule Version 2.2.0 are provided in the rule. SOAP 1.2 is one of the two supported envelope standards, and needs to be implemented over HTTP/S 1.1. The use of attachments is applicable to Batch processing, and is not applicable to Real time processing. Further, the intent of CAQH CORE 270: Connectivity Rule Version 2.2.0 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.
When testing with a CAQH CORE-authorized certification testing vendor check the NO REVISIONS NEEDED (not applicable) box for the detailed certification testing script(s) that do not apply when using SOAP (e.g., the 403 error messages tested under the Connectivity Test Script #2 because SOAP requires other types of error messages). As with all the Phase II CAQH CORE Certification Test Scripts, if you check NO REVISIONS NEEDED for a Test Script you will need to indicate to the testing vendor, in writing, your rationale for why the Test Script does not apply to you. In this case, you would indicate that you are using SOAP over HTTP/S to transport the X12 eligibility transactions.

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