---
kind: "section"
citation: "45 C.F.R. § 162.1203"
title: "45"
number: "162.1203"
heading: "Operating rules for eligibility for a health plan transaction."
url: "https://uscodex.org/cfr/45/162.1203"
---

# §162.1203. Operating rules for eligibility for a health plan transaction.


On and after January 1, 2013, the Secretary adopts the following:

- (a) Except as specified in [paragraph (b)](#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:
  - (1) **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](/cfr/45/162.920.md)).
  - (2) **Phase I CORE 153—** Eligibility and Benefits Connectivity Rule, version 1.1.0, March 2011. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
  - (3) **Phase I CORE 154—** Eligibility and Benefits 270/271 Data Content Rule, version 1.1.0, March 2011. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
  - (4) **Phase I CORE 155—** Eligibility and Benefits Batch Response Time Rule, version 1.1.0, March 2011. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
  - (5) **Phase I CORE 156—** Eligibility and Benefits Real Time Response Rule, version 1.1.0, March 2011. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
  - (6) **Phase I CORE 157—** Eligibility and Benefits System Availability Rule, version 1.1.0, March 2011. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
  - (7) **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](/cfr/45/162.920.md)).
  - (8) **Phase II CORE 259—** Eligibility and Benefits 270/271 AAA Error Code Reporting Rule, version 2.1.0. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
  - (9) **Phase II CORE 260—** Eligibility & Benefits Data Content (270/271) Rule, version 2.1.0, March 2011. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
  - (10) **Phase II CORE 270—** Connectivity Rule, version 2.2.0, March 2011. (Incorporated by reference in [§ 162.920](/cfr/45/162.920.md)).
- (b) **Excluding where the CAQH CORE rules reference and pertain to acknowledgements and CORE certification.**

## Notes

### 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]