CORE Certification
Operating Rules Mandate
CORE Certification Enforcement
CORE Board
CORE
CAQH CORE Claim Status Operating Rules
The Claim Status Operating Rules streamline the electronic process by which a provider requests the status of a claim and how the health plan responds. A set of these rules is federally mandated—more information on all CAQH CORE federally mandated rules can be found here.
CORE Participation
CAQH CORE Health Care Claims Operating Rules
The Health Care Claim Operating Rules streamline and standardize the exchange of information related to the submission, acknowledgment, and adjudication of healthcare claims, including attachments sent to support a claim submission.
Complete Set of Health Care Claim Operating Rules
CAQH CORE Health Care Claim (837) Infrastructure Rule vHC.2.0
CAQH CORE Attachments Health Care Claims Infrastructure Rule vHC.1.0
CAQH CORE Attachments Health Care Claims Data Content Rule vHC.1.0
Additional Medical Documentation/Attachments
CAQH CORE: Delivering Value through Electronic Healthcare Attachments
Attachments refer to the exchange of patient-specific medical information or supplemental documentation to support an administrative healthcare transaction and are a bridge between clinical and administrative data. However, the attachments workflow remains primarily manual and immensely burdensome. The main pain point often cited among industry is a lack of mandated attachments standards.