Medicare Claims Processing Manual (Pub. 100-04), Ch. 22 § 80
The Council for Affordable Quality Healthcare (CAQH)
80 – The Council for Affordable Quality Healthcare (CAQH)
Committee on Operating Rules for Information Exchange (CORE)
Mandated Operating Rules
(Rev. 3288, Issued: 07-02-15, Effective: 08-03-15, Implementation: 08-03-15)
Section 1104 of the Patient Protection and Affordable Care Act (ACA) establishes the
development and implementations of “requirements for administrative transactions that
will improve the utility of the existing HIPAA transactions and reduce administrative
costs.” A/B MACs/ CEDI/ and DME MACs are required to conform to the following
CAQH Core Operating Rules impacting the transmittals of X12 835 transactions.
A complete list of ACA mandated operating rules are available at
http://www.caqh.org/ORMandate_index.php.