Operating Rules CAQH CORE 270

Operating Rules CAQH CORE 270: Connectivity Rule Guidelines

Operating Rules CAQH CORE 270: Connectivity Rule requirements must be implemented by all entities seeking CORE Certification, including all other the CAQH CORE Eligibility and Claim Status Operating Rules.

Operating Rules CAQH CORE 270: Connectivity Rule  state that the CAQH CORE 270 Rule is applicable only to the public Internet, which is a TCP/IP based network. The Phase I CAQH CORE Connectivity Rule was based on use of the public Internet (which is TCP/IP based) for transport, and the Phase II CAQH CORE Connectivity Rule builds on Phase I, while retaining the same underlying transport. The CAQH CORE 270 Rule is applicable to and may be used when a CORE-certified entity is exchanging any X12 administrative transaction whether or not the transaction has been mandated under HIPAA. An entity that is Phase II CORE-certified is required to support the Phase II CAQH CORE 270: Connectivity Rule as a safe harbor (see Rule Section 5) when exchanging the X12 270/27, X12 276/277, and the ASC X12 Implementation Acknowledgement (999) transactions addressed in the CAQH CORE Operating Rules.

The CAQH CORE 270 Rule is designed to be payload agnostic, and as such it is expected, though not required, that CORE-certified entities will use this methodology for payloads other than eligibility and claim status, specifically for other X12 administrative transactions or other content such as HL7 clinical messages or personal health records.

Only those changes to the WSDL that preserve the structure and syntax of the message envelope are allowed. All field names, data types and syntax of existing fields must stay the same.

Adding extra fields is in conformance with the CAQH CORE Connectivity Rule when this is done within the HTTP+MIME envelope option. However, additional fields are likely to cause interoperability problems unless trading partners agree on their syntax and semantics, hence the use of such extra fields is discouraged. If fields are added to an HTTP+MIME envelope, such additions should be defined in the entity’s Companion Guide.

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