CAQH CORE Operating Rules for Benefit Enrollment and Maintenance

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Operating Rules	CORE Benefit Enrollment & Maintenance (834) Data Content Rule Version BEM.1.0	Final	Production		No	Free	Yes^$
Operating Rules	ORE Benefit Enrollment and Maintenance (834) Infrastructure Rule Version BE.3.0	Final	Production		No	Free	Yes^$

Limitations, Dependencies, and Preconditions for Consideration	Applicable Security Patterns for Consideration
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 between health plans and providers, and to ensure a more complete set of information in the response. CORE has developed operating rules for Benefit Enrollment and Maintenance which are available for voluntary use by covered entities. These have not yet been adopted through rulemaking by HHS. In 2023, new and updated CORE Benefit Enrollment and Maintenance Operating Rules were developed and approved by CORE Participants to facilitate the secure and standard collection and exchange of member socio-demographic information at the point of member enrollment into a health plan, or during maintenance of member data. Testing or certification with operating rules is voluntary and available through CORE. CORE maintains free tools to support operating rule implementation. Additionally, CAQH CORE offers educational webinars on its website.	Feedback requested.

Limitations, Dependencies, and Preconditions for Consideration

Applicable Security Patterns for Consideration

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 between health plans and providers, and to ensure a more complete set of information in the response.
CORE has developed operating rules for Benefit Enrollment and Maintenance which are available for voluntary use by covered entities. These have not yet been adopted through rulemaking by HHS.
In 2023, new and updated CORE Benefit Enrollment and Maintenance Operating Rules were developed and approved by CORE Participants to facilitate the secure and standard collection and exchange of member socio-demographic information at the point of member enrollment into a health plan, or during maintenance of member data.
Testing or certification with operating rules is voluntary and available through CORE. CORE maintains free tools to support operating rule implementation. Additionally, CAQH CORE offers educational webinars on its website.

Feedback requested.

Comment

Submitted by mphillips@caqh.org on 2024-08-09

CAQH CORE 2025 ISA Updates

Recommended updates to the Operating Rules for Benefit Enrollment and Disenrollment are included on pages 6-7 of the attached document.

CORE Submission_2025 ISA Updates_BEM.pdf

Submitted by mphillips@caqh.org on 2023-10-06

Recommended Updates to the Benefit Enrollment PAge

CORE recommends several substantive content and clarifying changes to the CAQH CORE Operating Rules for Benefit Enrollment and Disenrollment. The changes are outlined on Page 4 of the letter found at this link: CORE Submission for the 2024 ISA Open Comment Period.

Submitted by mphillips@caqh.org on 2022-09-27

CAQH CORE Operating Rules for Benefit Enrollment Updates

Updates to the CAQH CORE Operating Rules for Benefit Enrollment are on pages 13-14 in the attached document. Proposed changes are primarily non-substantive in nature and address consistency, conciseness, and grammar and syntax. Changes are highlighted in gray with proposed deletions shown as strikethrough text.

CAQH CORE ISA Letter 2022_5.pdf