Updated Version of CORE Code Combinations Available for Implementation

Updated Version Available for Implementation: June 2014 CORE Code Combinations v3.1.0 - Includes Adjustments for 2013 Market-Based Review and the Latest Compliance-based Review To: All HIPAA Covered Entities and Business Associates    From: The CAQH CORE Code Combinations Task Group Co-Chairs    An updated version of the CORE-required Code Combinations for the CORE-defined Business Scenarios (CORE Code Combinations) is now available for use with CAQH CORE 360: Uniform Use of CARCs and RARCs Rule. CAQH CORE Rule 360 enables more uniform use of the Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) by targeting a minimum set of common or problematic Business Scenarios, along with a maximum specified set of code combinations for each of these Scenarios. Per CAQH CORE policy, the CORE Code Combinations must be updated by Task Group approval to both: Align with the current published CARC and RARC lists which are maintained by code committees and updated at least three times per year. (Compliance-based reviews) Address an annual review. (Market-based reviews)      The CORE-required Code Combinations for the CORE-defined Business Scenarios v3.1.0 June 2014 is now available on the CAQH CORE website for use with CAQH CORE 360 Rule. The June 2014 CORE Code Combinations includes: Compliance-based Adjustments as a result of code list updates published on March 1st and March 15th Market-based Adjustments based upon the 2013 Market-based Review Emergency Code Combination Additions1 Non-substantive updates have been made for ease of use A marked-up version of the June 2014 CORE Code Combinations showing both Compliance-based and Market-based Adjustments between v.3.0.4 and v.3.1.0 is available HERE. The Change Log in the second tab of the CORE Code Combinations provides a list of all adjustments made to the CORE Code Combinations. The format of the CORE Code Combinations was updated per request of CORE and non-CORE participants ease of use to include: A row for each CARC that does not require a RARC so implementers may easily view available code combinations that only include a CARC and CAGCs A Master Tab added to the current version that includes all CORE Code Combinations in a single tab For more information visit the Ongoing Maintenance of the CORE Code Combinations for CAQH CORE 360 Rule Webpage, a "one stop shop" for all the necessary tools and information to comply with CAQH CORE 360 Rule and the ongoing maintenance process. This website page include summary of the updates and links to detailed updates. The CAQH CORE Code Combinations Task Group will launch its next Compliance-based Review in July in order to review updates from the code list authors that are scheduled for publication in July, 2014. CAQH CORE Participants are encouraged to get involved with the Task Group. Beyond the Compliance-based review, the Task Group will also begin planning for process improvements for the annual Market-based Review. Please do not hesitate to contact core@caqh.org with any additional questions.   [1] Emergency Code Combination Additions (ECCA) are code combinations that originated through the formal ECCA Request Process  These requests could be in response to newly enacted federal or state legislative or regulatory action or to support new product lines offered to the market by public (e.g., Medicare, Medicaid) or commercial health plan issuers. Per policy, they are very limited and require co-chair approval.