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  • The CAQH CORE, EFT and ERA Operating Rule Set
  • Post author
    Lacy Gaskins

The CAQH CORE, EFT and ERA Operating Rule Set

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) comply with the CAQH CORE, EFT and ERA Operating Rule Set developed by the Department of Health and Human Services (DHHS) as part of the Affordable Care Act (ACA) – with attention to CARC/RARC and CAGC combinations.

Full Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3915CP.pdf

Subject: Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): CORE 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE)

Number: 3915

Title: 10268

Release Date: November 9, 2017

Effective Date: April 1, 2018

Implementation Date: April 2, 2018

Special Notes: N/A

  • Post author
    Lacy Gaskins