CAQH CORE Operating Rules for Connectivity

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Operating Rules	CAQH® CORE Operating Rules for Connectivity	Final	Production		Yes	Free	Yes^$

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
Operating rules for HIPAA standard transactions were added as a requirement of the Patient Protection and Affordable Care Act of 2010, under Section 1104, Administrative Simplification. Operating rules are intended to support and enhance the use of standard transactions. They may include certain requirements to help implement the transaction in a more uniform way across health plans and ensure a more complete set of information in the response. The CORE Operating Rules for Connectivity support the adoption and implementation of transaction-based operating rules by establishing key requirements to maintain the secure exchange of health care information. In 2012 and 2013 HHS adopted two versions of the CORE Connectivity Rules, which were incorporated by reference at §162.920. Prior versions of the CAQH CORE Operating Rules for Connectivity are available on the CAQH CORE Mandated Operating Rules website. In 2020, CAQH CORE updated its Operating Rules for Connectivity to version C4.0.0 to enhance security protocols, and to support REST and SOAP. The updated Rule is available for voluntary use by covered entities. CORE Connectivity Rule vC4.0.0 was recommended for Federal adoption by the National Committee of Vital Health and Statistics (NCVHS) to the Department of Health and Human Services (HHS) in June 2023. Testing or certification with operating rules is voluntary and available through CORE. CORE maintains free tools to support operating rule implementation. Additionally, CORE offers educational webinars on its website. Portions of the CORE Connectivity Rule are mandated for the Eligibility, Claim Status, ERA and EFT operating rules. Others may be adopted at a future date.	Feedback requested.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

Operating rules for HIPAA standard transactions were added as a requirement of the Patient Protection and Affordable Care Act of 2010, under Section 1104, Administrative Simplification.
Operating rules are intended to support and enhance the use of standard transactions. They may include certain requirements to help implement the transaction in a more uniform way across health plans and ensure a more complete set of information in the response.
The CORE Operating Rules for Connectivity support the adoption and implementation of transaction-based operating rules by establishing key requirements to maintain the secure exchange of health care information.
In 2012 and 2013 HHS adopted two versions of the CORE Connectivity Rules, which were incorporated by reference at §162.920.
Prior versions of the CAQH CORE Operating Rules for Connectivity are available on the CAQH CORE Mandated Operating Rules website.
In 2020, CAQH CORE updated its Operating Rules for Connectivity to version C4.0.0 to enhance security protocols, and to support REST and SOAP. The updated Rule is available for voluntary use by covered entities.
CORE Connectivity Rule vC4.0.0 was recommended for Federal adoption by the National Committee of Vital Health and Statistics (NCVHS) to the Department of Health and Human Services (HHS) in June 2023.
Testing or certification with operating rules is voluntary and available through CORE. CORE maintains free tools to support operating rule implementation. Additionally, CORE offers educational webinars on its website.
Portions of the CORE Connectivity Rule are mandated for the Eligibility, Claim Status, ERA and EFT operating rules. Others may be adopted at a future date.

Feedback requested.

Comment

Submitted by mphillips@caqh.org on 2023-10-06

Updates to the CORE Connectivity Page

CORE recommends several substantive content and clarifying changes to the CAQH CORE Operating Rules for Connectivity website. The changes are outlined on Page 7-8 of the letter found at this link: CORE Submission for the 2024 ISA Open Comment Period.

Submitted by pwilson@ncpdp.org on 2023-10-06

NCPDP Comment

NCPDP recommends that ONC add the following:

Type- Operating Rules

Standard Implementation/Specification- Operating Rule Connectivity, V2.0

Standards Process Maturity – Final

Implementation Maturity- Feedback Requested

Adoption Level – 1

Federally Required – No

Cost – $

Test Tool Availability – No

Submitted by shellyspiro on 2023-10-02

Pharmacy HIT Collaborative (PHIT) comment

PHIT supports NCPDP’s recommendation adding Operating Rule Connectivity, V2.0 to operating rules.

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CAQH CORE Operating Rules for Connectivity

Comment

Updates to the CORE Connectivity Page

NCPDP Comment

Pharmacy HIT Collaborative (PHIT) comment

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