Two federal regulations mandate compliance with the following CAQH® CORE® Operating Rules, as required under the Patient Protection and Affordable Care Act of 2010:
These Operating Rules were originally issued as Phase I, Phase II, and Phase III rules. CAQH CORE reorganized their rules by transactions in 2020. Rule content and requirements did not change. For more information, see https://www.caqh.org/core/new-operating-rule-structure.
All applicable Change Healthcare products and services comply with these regulations.
The CAQH® CORE® Eligibility & Benefits Operating Rules pertain to the X12/005010X279A1 Eligibility Benefit Inquiry and Response (270/271) transaction.
The CAQH® CORE® Claim Status Operating Rules pertain to the X12/005010X212 Health Care Claim Status Request and Response (276/277) transaction.
The Claim Status Operating Rules are:
The CAQH® CORE® Payment and Remittance Operating Rules pertain to:
CAQH® CORE® offers a voluntary certification program which serves to demonstrate an entity’s conformance to all of its Operating Rules.
Change Healthcare has achieved voluntary certification for the Eligibility & Benefits Operating Rules, the Claim Status Operating Rules (Phase I and II, at the time of certification), and the Payment & Remittance Operating Rules (Phase III at the time of certification).
See Change Healthcare Accreditations & Certifications for additional information.
X12 manages the exclusive copyright to all X12 standards, publications, and products; see https://x12.org/products/ip-use for details. The X12 TR3 that details the full requirements for this transaction can be licensed at https://x12.org/licensing.
CORE®, the CORE-certification/Endorser Seals and logo are registered trademarks of CAQH®, copyright 2021, Council for Affordable Quality Healthcare®.