April 04, 2024

CAQH Updates CORE Healthcare EFT Enrollment Rules to Streamline Claim Payments

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The Council for Affordable Quality Healthcare (CAQH) owns and manages the CORE Operating Rules. The Healthcare EFT Enrollment Rules were just updated to help health claim payments move more efficiently and effectively while aiming to reduce fraud.  

Three rules were updated:

  1. CORE Payment & Remittance EFT Enrollment Data Rule Version PR.2.0 (effective March 2024).
  2. Framework for Semantic Interoperability in Value-based Payments Version SI.1.0 (effective December 2023).
  3. CORE Health Care Claims (837) Data Content Rule Version HC.1.0 (effective December 2023).

CORE Payment & Remittance EFT Enrollment Data Rule Version PR.2.0

Overall, the rule applies to health plans, their agents and vendors offering EFT enrollment. It defines the maximum set of data elements required for successful EFT enrollment. These data elements ensure efficient communication between providers and payers.

The key enhancements in this update include:

  • Securing enrollment data and forms to mitigate fraud risks.
  • Expanding scope of the rule to support bulk enrollment capabilities.
  • Ensuring efficient and timely delivery of enrollment notifications.
  • Providing transparency on EFT fees and guidance on opt-in/opt-out processes for non-EFT electronic payment methods.