In September 2015, the CAQH Committee on Operating Rules for Information Exchange (CORE®) approved the Phase IV Operating Rules for their voluntary certification process.
The Phase IV Operating Rules address the following ASC X12N transactions:
The Phase IV Operating Rules are as follows:
For each transaction, the Phase IV Operating Rules define the following requirements:
View the Phase IV Operating Rules
View Additional Information on CAQH CORE
On July 6, 2016, the National Committee on Vital and Health Statistics (NCVHS), advisory body to the Department of Health and Human Services, recommended that the Phase IV Operating Rules not be adopted under regulatory mandate and instead supported voluntary industry adoption. Recommendations also included; addressing inconsistencies in authentication and connectivity requirements, regulatory adoption of the acknowledgement standard as HIPAA-mandated, and transaction-specific findings and recommendations.
To see the NCVHS recommendation, go to www.ncvhs.hhs.gov.
Regulatory action on the Phase IV operating rules is not anticipated.
CAQH CORE offers a voluntary certification program which serves to demonstrate an entity’s conformance to the Phase IV Operating Rules.
Change Healthcare supports the NCVHS recommendations and will not seek CORE Phase IV voluntary certification until the recommendations are addressed or further regulatory clarifications are communicated.