- Operating rules for HIPAA standard transactions were added as a requirement of the Patient Protection and Affordable Care Act of 2010, under Section 1104, Administrative Simplification.
- Operating rules are intended to support and enhance the use of standard transactions. They may include certain requirements to help implement the transaction in a more uniform way across health plans and ensure a more complete set of information in the response.
- The CORE Operating Rules for Connectivity support the adoption and implementation of transaction-based operating rules by establishing key requirements to maintain the secure exchange of health care information.
- In 2012 and 2013 HHS adopted two versions of the CORE Connectivity Rules, which were incorporated by reference at §162.920.
- Prior versions of the CAQH CORE Operating Rules for Connectivity are available on the CAQH CORE Mandated Operating Rules website.
- In 2020, CAQH CORE updated its Operating Rules for Connectivity to version C4.0.0 to enhance security protocols, and to support REST and SOAP. The updated Rule is available for voluntary use by covered entities.
- CORE Connectivity Rule vC4.0.0 was recommended for Federal adoption by the National Committee of Vital Health and Statistics (NCVHS) to the Department of Health and Human Services (HHS) in June 2023.
- Testing or certification with operating rules is voluntary and available through CORE. CORE maintains free tools to support operating rule implementation. Additionally, CORE offers educational webinars on its website.
- Portions of the CORE Connectivity Rule are mandated for the Eligibility, Claim Status, ERA and EFT operating rules. Others may be adopted at a future date.