Eligibility & Benefits Standards and Operating Rules

The Health Care Eligibility Benefit Inquiry and Response and the associated X12 Technical Report Type 3 Implementation Guides provide the HIPAA-adopted standards for healthcare eligibility and benefit inquiries. These guides provide standardized data content for creation and use of the v5010 270/271 transaction. The 270 transaction set is used throughout the healthcare marketplace to transmit healthcare eligibility and benefit inquiries from health care providers, insurers, clearinghouses and other healthcare adjudication processors.

Electronic Payment Impact on Dental Practice Financials

Join CAQH CORE and Nacha for a webinar to learn about how electronic payments improve the dental practice revenue cycle. Hear from Dr. Hope Watson, DMD, who will discuss how accepting EFT claim payments has benefited Watson Family Dentistry. This webinar will also address common EFT misconceptions and highlight how providers can reap rewards when working with dental plans and vendors who have adopted EFT standards and their supporting operating rules help to streamline payments.

Join us June 8 to improve your practice’s financials!


Featured Speakers:

No Surprises Here: Recommendations from the CAQH CORE Advanced Explanation of Benefits Advisory Group

Join CAQH CORE staff for an update on the Advanced Explanation of Benefits (EOB) Advisory Group’s efforts to develop consensus-based recommendations to support components of the Advanced EOB requirements in the No Surprises Act.

What will you learn by registering for this webinar?

X12 and CAQH CORE Webinar Series: A Conversation on the 835 Transaction, Standard & Operating Rules

The X12 005010X221A1 Health Care Claim Payment/Advice (835) TR3 Implementation Guide is the HIPAA-adopted standard for claim payment/advice. This guide provides standardized data content for creation and use of the 835 transaction. The 835 is used throughout the healthcare marketplace by providers to post claim payments and adjustments to their accounting systems. CAQH CORE Payment & Remittance Operating Rules help the industry more effectively implement and use the 835 transaction to understand payment decisions and optimize denial management.