§162.1203. Operating rules for eligibility for a health plan transaction.
45 C.F.R. § 162.1203
On and after January 1, 2013, the Secretary adopts the following:
Except as specified in paragraph (b) of this section, the following CAQH CORE Phase I and Phase II operating rules (updated for Version 5010) for the eligibility for a health plan transaction:
Phase I CORE 152— Eligibility and Benefit Real Time Companion Guide Rule, version 1.1.0, March 2011, and CORE v5010 Master Companion Guide Template. (Incorporated by reference in § 162.920).
Phase I CORE 153— Eligibility and Benefits Connectivity Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).
Phase I CORE 154— Eligibility and Benefits 270/271 Data Content Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).
Phase I CORE 155— Eligibility and Benefits Batch Response Time Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).
Phase I CORE 156— Eligibility and Benefits Real Time Response Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).
Phase I CORE 157— Eligibility and Benefits System Availability Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).
Phase II CORE 258— Eligibility and Benefits 270/271 Normalizing Patient Last Name Rule, version 2.1.0, March 2011. (Incorporated by reference in § 162.920).
Phase II CORE 259— Eligibility and Benefits 270/271 AAA Error Code Reporting Rule, version 2.1.0. (Incorporated by reference in § 162.920).
Phase II CORE 260— Eligibility & Benefits Data Content (270/271) Rule, version 2.1.0, March 2011. (Incorporated by reference in § 162.920).
Phase II CORE 270— Connectivity Rule, version 2.2.0, March 2011. (Incorporated by reference in § 162.920).
Excluding where the CAQH CORE rules reference and pertain to acknowledgements and CORE certification.
Notes, amendments, and revision history
Amendments
[76 FR 40496, July 8, 2011]
Authority
Authority: 42 U.S.C. 1320d—1320d-9 and secs. 1104 and 10109 of Pub. L. 111-148, 124 Stat. 146-154 and 915-917.
Source
Source: 65 FR 50367, Aug. 17, 2000, unless otherwise noted.
Amendments
[76 FR 40496, July 8, 2011]