CORE is the Committee on Operating Rules within CAQH, an alliance of industry stakeholders. The rules are designed to make HIPAA transactions far more standardized, and CORE is developing many of the rules. It has worked with the Electronic Payments Association, a banking group, on the financial transactions.
CORE developed first and second phases of operating rules for eligibility verification/benefits determination and claim status transactions. Operating rules for electronic funds transfer and electronic remittance advice are in the draft stage. The Centers for Medicare and Medicaid Services recently issued an interim final rule to require adoption of EFT/ERA operating rules, following a similar interim final rule in July 2011 for the eligibility and status operating rules. Adoption of remaining operating rules will come as industry compliance is mandated in stages between 2013 and 2016.
CAQH is hosting the Town Hall on Jan. 24 to provide an informal update on CORE activities. The meeting link is here. A presentation on the CORE rules for eligibility and claim status is here with the draft EFT and ERA rules presentation here.
Upcoming Town Halls are scheduled on March 13, April 24 and June 12. More information is available at caqh.org/core.
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