CAQH CORE Operating Rules for Eligibility and Claims Status Operating rules for eligibility and claims status went into effect on January 1, 2013. They make it easier for providers to determine: Whether a patient is eligible for coverage (transaction 270/271) The status of a health care claim submitted to a health insurer (transaction 276/277) Eligibility Read More →

EDI HIPAA operations

Health Care Claims Subgroup Co-Chairs: Rule Development Update As representatives of healthcare business services companies, provider organizations, health plans, and associations, CAQH CORE spends time optimizing data transmission workflows to improve healthcare administration in our day-to-day jobs. Within the health care claims processing landscape, efficiency remains a key challenge. Per the 2022 CAQH Index, over 9 Read More →

CAQH CORE Health Care

CAQH CORE Health Care Operating Rules Mandated Under HIPAA Operating rules support a range of standards to make electronic data transactions more predictable and consistent, regardless of the technology. CAQH CORE is designated by the Secretary of the Department of Health and Human Services (HHS) as the National Operating Rule Authoring Entity for the administrative Read More →


CMS Operating Rules EFT and Remittance Advice Operating rules for the EFT and ERA transactions (CMS – Centers for Medicare & Medicaid Services) went into effect on January 1, 2014. To understand the operating rules it is important to be familiar with the two transactions: What is an Electronic Funds Transfer (EFT)? An electronic funds transfer, or EFT, Read More →