The CAQH Committee on Operating Rules for Information Exchange (CORE®) developed the Phase I Operating Rules for their voluntary Phase I certification program. The Phase I rules were originally developed to address the 4010 version of the Health Care Eligibility Benefit Inquiry and Response (270/271). The Phase I rules were updated to align with the 5010 version of the 270/271 and were adopted by CORE in March 2011.
The Phase I Operating Rules are as follows:
The Phase I Operating Rules include requirements for:
View the Phase I Operating Rules
CORE developed the Phase II Operating Rules for their voluntary Phase II certification program. The Phase II rules were originally developed to address version 4010 of the Health Care Eligibility Benefit Inquiry and Response (270/271) and the Health Care Claim Status Request and Response (276/277). The Phase II rules were updated to align with the 5010 version of the 270/271 and the 276/277 and were adopted by CORE in March 2011.
The Phase II Operating Rules are as follows:
The Phase II rules
View the Phase II Operating Rules
View Additional Information on CAQH CORE
On August 10, 2012 the Department of Health and Human Services published the Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions; Interim Final Rule which required HIPAA covered entities to conform to a subset of the CAQH CORE Phase II Operating Rules.
Although this Interim Final Rule adopted the majority of the CORE Phase I and II Operating Rules, it excluded rules referencing acknowledgments and CORE certification.
All Change Healthcare products and services comply with the Eligibility and Claim Status Operating Rules IFC.
View the Change Healthcare Operating Rules Readiness Document
CAQH CORE offers a voluntary certification program which serves to demonstrate an entity’s conformance to Phase I and II Operating Rules.
The federally issued Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions; Interim Final Rule excluded rules referencing acknowledgments and CORE certification.
Change Healthcare is Phase I and II certified for Real-time and Batch Transaction Processing and Data Hosting Services.