CAQH CORE 250 Claim Status Infrastructure Rule Certification CAQH CORE 250 Rule states that an entity that processes X12 270/271 eligibility transactions, and does not process claim status transactions can become Phase II CORE-certified.  Phase II CAQH CORE Operating Rules do not require an organization to conduct, use or process the X12 276/277 claim status transactions Read More →

CAQH CORE 156 Rule Transactions Tracking: How should the X12 270/271 transactions be tracked? CAQH CORE 156 Rule Transactions tracking can be done throughout a system/application to demonstrate conformance with the response time requirements specified in the CAQH CORE 156 Rule. The CAQH CORE Response Time Rules (CAQH CORE 155 & 156 Rules) require HIPAA covered entities to capture, log, Read More →

  CAQH CORE 156: Real Time Response Time Rule Basic Guidelines CAQH CORE 156: Real Time Response Time Rule indicates that the number of responses returned within the specified timeframe gives a better indication of the information source’s capabilities. Averages can be skewed by outlier responses. Providers do not have to be certified by CAQH CORE to Read More →

CAQH CORE 154 X12 271 Response Back Guides CAQH CORE 154 X12 271 response with the health plan name (assuming it is available within the system[s]) in EB05 element of all EB segments sent back in the response has some notes. Since the CAQH CORE 154 Rule does not explicitly identify which EB segments are to carry Read More →

CAQH CORE 154 Eligibility & Benefits 270/271 Data Content Rule CAQH CORE 154 Eligibility & Benefits 270/271 eligibility data content rule subjects to the general CAQH CORE 260 Rule X12 270/271 requirements. CAQH CORE 154 Eligibility & Benefits 270/271 Guidelines Code 52 is specific to hospital emergency services; Code 86 is general. CAQH CORE selected Code 86 so that Read More →

CAQH CORE 154 Eligibility & Benefits 270/271 Data Content Rule CAQH CORE 154 Eligibility & Benefits 270/271 eligibility data content subjects to the Phase I and general CAQH CORE 260 Rule rule requirements for the X12 270/271. CAQH CORE 154 Eligibility & Benefits 270/271 Notes The CAQH CORE 154 Eligibility & Benefits (270/271) Data Content Rule Version 1.1.0 does not Read More →

EDI Payer Initiated Eligibility/Benefit Transaction (Washington State Medicaid) Additional Guides EDI Payer Initiated Eligibility/Benefit Transaction transmission must be secure in accordance with 45 CFR Parts 160, 162, and 164 Health Insurance Reform: Security Standards. Control segments/envelopes EDI Payer Initiated Eligibility/Benefit Transaction conforms to ASC X12 Control Segments / Envelopes (ISA-IEA, GS-GE, and ST-SE) for Version Read More →