EDI Testing CAQH CORE 153 Trading Partner Guidelines

EDI Testing CAQH CORE 153 Basics must be combined when determining the overall CAQH CORE Connectivity requirements. Find the fourth part of EDI Testing CAQH CORE FAQs for trading partners below.

1.For batch response pick-up, does CAQH CORE intend for this to be a programmatic interface or a human interface?

Under the CAQH CORE Operating Rules, information sources must provide a programmatic interface to allow an automated task whereby the provider’s system requests the batch of X12 271 responses be transferred to the provider’s system without a need for human intervention.

2. Can a clearinghouse or vendor act on behalf of a health plan for the CAQH CORE 153: Connectivity Rule?

Yes. Each health plan seeking CORE Certification would have to work with its clearinghouse and/or vendor to jointly complete CORE Certification testing in order for the health plan to be awarded the CORE Certification Seal. A clearinghouse or vendor would not be able to certify “generically” as a health plan and then transfer such certification to any health plan.

3. Can my organization run an X12 270/271 transaction on XML?

An XML-based eligibility inquiry and response equivalent to the X12 270/271 cannot be used in place of HIPAA-mandated standard form as specified in the X12 270/271 TR3. However, your organization can accept the X12 270 into its EDI system either directly from a provider or through a clearinghouse and then convert it into another format for internal processing, e.g., XML or some other proprietary format. Also, for the purposes of the CAQH CORE Connectivity Rule, organizations can specify an XML based message “wrapper” around the X12 Interchange of 270 and 271 transactions.

4. For real time transactions, our system does not automatically resend failed responses, however the client can go in and send the same request manually. Must we prevent the client from being able to resubmit the same request (even manually) for 90 seconds after the original request was sent?

Yes, whether it is an automated or manual re-send, the re-send attempts cannot occur more frequently than what is specified in the CAQH CORE Operating Rule.

5. How should we respond to the transaction if the date/time and/or payload ID are not present?

Such a message would represent a CAQH CORE non-compliant message. The Phase I CAQH CORE 153: Connectivity Rule does not require such a message to be either rejected or accepted by the receiver. It is the receiver’s decision regarding acceptance of a non-compliant message.

6. Is there a more precise definition as to where user ID, Password, date/time and payload ID should appear in the data stream? The document references “HTTP Message Body” and “HTTP Message Header Tags.”

There are no more precise specifications in the Phase I CAQH CORE 153: Connectivity Rule. This decision is left to the message originator.

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