CAQH Operating Rules Committee
HFMA participates in an industry-wide initiative to develop operating rules for transmitting eligibility and benefits information. The Committee on Operating Rules for Information Exchange (CORE), spearheaded by the Council for Affordable Quality Healthcare (CAQH), is a self-governing body comprised of representatives from health plans, providers, technology vendors, and other stakeholders.
The rules will build on the HIPAA 270/271 transactions for eligibility benefits and address which health plan covers the patient and confirmation of service type, copay amount, coinsurance levels, and base deductible levels.
View the CORE FAQs