HIPAA / EDI Publications

CAQH CORE

We have completed the development of applications and processes that comply with ACA mandated CAQH CORE operating rules for Phase I, II and III. IT has also completed testing with the CAQH approved testing vendor Edifecs to make sure the solutions are compliant with the CORE requirements and we are currently in the process of obtaining certification (CORE Seals) from CAQH for all the three phases.

• Phase - I - Operating rules for exchanging batch and real time 270/271 eligibility request and response transactions
• Phase - II - Operating rules for exchanging 276/277 claims status request and response transactions
• Phase - III - Operating rules for enrolling and exchanging ERA (835) / EFT transactions

CORE Materials

• CORE Compliant: Real – Time Transaction 276/277 Companion Guide
• ​​CORE Compliant: Real – Time Transaction 276/277 Enrollment Form

• CORE Complaint: 835/ERA Retrieval Transactions Companion Guide
• CORE Complaint: 835/ERA Retrieval Transactions Enrollment Form​

Go to the CAQH CORE​ website at http://www.caqh.org/core if you need any additional information.
If you are interested in working with us to test any of the solutions above or any or all of the three phases, or have any questions about these rules and/or solutions, please contact our enrollment and testing team at:

PHC EDI Enrollment & Testing
Partnership HealthPlan of California
4665 Business Center Drive, Fairfield, CA 94534
Phone:  (707) 863-4527
Fax:  (707) 863-4390
Email: EDI-Enrollment-Testing@partnershiphp.org
www.partnershiphp.org