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ACA Operating Rules

CAQH CORE is a multi-stakeholder collaboration developing industry-wide operating rules, built on existing standards, to streamline administrative transactions. The Affordable Care Act (ACA) Operating Rules address gaps in standards, help refine the infrastructure that supports EDI, and recognize interdependencies among transactions. The ACA Operating Rules include enhancements for several transactions: X12 270/271 Eligibility & Benefits Inquiry/Response, X12 276/277 Claim Status Inquiry/Response, and X12 835 Claim Payment/Remittance Advice.

The ACA Operating Rules address two areas: data content and infrastructure.

  • Data content. The data content rules provide for robust verification with enhanced error reporting.
  • Infrastructure. The infrastructure rules address companion guides, system availability, responses, response times, and connectivity using a secure machine-to-machine internet exchange.

Because this alternative method is a machine-to-machine connection, submitters should verify program capability with their software vendor.

Registration is required to submit transactions using an internet connection. For more information, see the ACA Registration page.

Additional Resources: