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.

Join the CAQH CORE Team to learn more about new and updated CAQH CORE Operating Rules approved with overwhelming support in late 2020 for industry implementation, including:

The CORE Code Combinations organize claim denial and adjustment codes into unique business scenarios for more consistent code use across industry. CAQH CORE conducts a biennial Market-based Review (MBR) of the CORE Code Combinations to address industry business needs.

CAQH CORE will provide an update of its work efforts and priority initiatives for 2021 to deliver administrative efficiency and value to the healthcare industry. Topics will include:

CAQH CORE will provide an update of its work efforts and priority initiatives to deliver administrative efficiency and value to the healthcare industry. 

Register for this Town Hall to engage with CAQH CORE and provide input on how to best drive the industry towards fully digital business operations. For any questions, please contact CAQH CORE staff at CORE@caqh.org.

Starting in 2021, CORE-certified entities will be required to renew their CORE Certifications every three years on a rolling basis. Register for this webinar to understand how to assess ongoing conformance with the operating rules through CORE Recertification. Webinar highlights will include:

Plan to Cast Your Vote by Friday, December 4th: The CAQH CORE Connectivity & Security Work Group recently passed a ballot approving the draft CAQH CORE connectivity rule and the CAQH CORE Review Work Group approved a set of draft value-based payments rules focused on patient attribution. The next step in the CAQH CORE voting process is the Final Vote which opens on November 16^th and closes on December 4th.

In a collaboration between the Centers for Medicare and Medicaid Services (CMS), WEDI and CAQH CORE, the CMS National Standards Group will provide an overview of the HIPAA Standards Exceptions Request Process to allow organizations to request an exception from the use of a standard from the HHS Secretary to test a proposed modification to that standard.

Following the presentation, time will be allocated for Q&A, with questions submitted prior to the webinar. Please submit your questions during the webinar registration process.

CAQH CORE will provide an update of its 2020 Goals and priority initiatives to deliver administrative efficiency and value to the healthcare industry. Topics will include:

CAQH CORE, together with Cleveland Clinic and PriorAuthNow (PAN), is pleased to share initial findings highlighting the impact of greater prior authorization (PA) automation and workflow integration leveraging standards and operating rules at Cleveland Clinic. The Cleveland Clinic will share how the implementation of an integrated PA solution is improving the ability of staff to conduct PAs and creating a more efficient process.