- Adoption of operating rules for HIPAA standards is a requirement of the Patient Protection and Affordable Care Act of 2010, under section 1104, Administrative Simplification.
- In 2012 and 2013 HHS adopted the Phase I, II and III CAQH CORE Operating Rules including two versions of the CORE Connectivity Rule embedded in these operating rules, which were incorporated by reference at §162.920.
- CAQH CORE has updated Operating Rules for Connectivity to enhance security protocols, and to support REST and SOAP. Updated rules are available for voluntary use by covered entities.
- Adopted operating rules are incorporated by reference at § 162.920 and are available on the CAQH CORE Mandated Operating Rules website.
- In 2020, CAQH CORE updated its phase-based operating structure to align with the business processes of covered entities. The phased structure was retired. HHS has not released new policies or guidance to adopt the documents or revisions.
- Testing, or certification with the operating rules is voluntary and available through a vendor contracted to the authoring entity. There is a fee for certification, however, CAQH CORE maintains free tools to support operating rule implementation. Additionally, CAQH CORE offers educational webinars which are archived on its website.
- Note: Portions of the Updated Connectivity Rule are mandated for the Eligibility, Claim Status, ERA and EFT operating rules. Others may be adopted at a future date.