Implementation of CAQH CORE Phase III Operating Rules in NCTracks

The Council for Affordable Quality Healthcare (CAQH) is a nonprofit alliance of health plans and trade associations. The Committee on Operating Rules for information Exchange (CORE) is an initiative through CAQH to promote streamlining and ease of use for physicians and hospitals to access eligibility, benefits and claim information for their patients at the point of care. Implementation of the CAQH CORE operating rules is a mandate of the Affordable Care Act. (For more information about CAQH CORE, see link below.)

System changes associated with Phases I and II of the CAQH CORE standards were implemented in NCTracks in March 2014. Enhancements to Recipient Eligibility Inquiry and Claim Status were made to the secure NCTracks Provider Portal, HIPAA X12 transactions, and the Automated Voice Response System (AVRS). For more information regarding the Phase I and II enhancements, see the March 24 announcement.
NCTracks is implementing the next phase of CAQH CORE rules, Phase III, which will provide access to more data and increase the transactions available via CORE’s connectivity methodology, as summarized below:
  •  NCTracks will now be able to support the CAQH CORE Connectivity Rule for transmission of the 835 and 820 X12 transactions, along with the 270/271 and 276/277 X12 transactions, which were implemented in Phases I and II. This includes a provision for retransmission of 835 and 820 X12 transactions generated within the previous 90 days.
  • To support CORE rules functionality, NCTracks will generate the 277P, 820, 834, and 835 X12 transactions by provider number (NPI/Atypical ID) rather than by TSN as it is done today.
  • Trading Partners and providers will now have the ability to delete files from their mailboxes
  • There will be a new Trading Partner Roles Page in the secure Provider Portal for user provisioning associated with CAQH CORE. Any existing CAQH CORE transaction roles will need to be re-established using the new Trading Partner Roles Page.
In addition, the Electronic Funds Transfer (EFT) enrollment process on the secure Provider Portal will be modified to match CAQH CORE standards.   Similarly, the enrollment process on the secure Provider Portal for receipt of the Electronic Remittance Advice (ERA), also known as the 835 X12 transaction, will be modified for CAQH CORE. However, existing providers will not need to make any changes to their EFT or ERA enrollment.
The CAQH CORE changes in NCTracks do not affect delivery of the paper remittances to the provider Message Center Inbox or delivery of standard X12 files to their mailbox.
The NCTracks Connectivity Guide, as well as the Companion Guides for the 835 and 820 X12 transactions, will be updated to reflect changes associated with CAQH CORE. The Guides can be found on the Trading Partner Information page of the NCTracks Provider Portal.
More information will be sent to Trading Partners shortly regarding the upcoming CAQH CORE changes. Any questions should be directed to the NCTracks Call Center at 1-800-688-6696 or NCTracksprovider@nctracks.com.