{"data":{"id":"us/45-cfr-162.1203","jurisdiction":"us","citation":"45 CFR 162.1203","heading":"Operating rules for eligibility for a health plan transaction.","body":"On and after January 1, 2013, the Secretary adopts the following:\n(a) Except as specified in paragraph (b) of this section, the following CAQH CORE Phase I and Phase II operating rules (updated for Version 5010) for the eligibility for a health plan transaction:\n(1) Phase I CORE 152: Eligibility and Benefit Real Time Companion Guide Rule, version 1.1.0, March 2011, and CORE v5010 Master Companion Guide Template. (Incorporated by reference in § 162.920).\n(2) Phase I CORE 153: Eligibility and Benefits Connectivity Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).\n(3) Phase I CORE 154: Eligibility and Benefits 270/271 Data Content Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).\n(4) Phase I CORE 155: Eligibility and Benefits Batch Response Time Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).\n(5) Phase I CORE 156: Eligibility and Benefits Real Time Response Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).\n(6) Phase I CORE 157: Eligibility and Benefits System Availability Rule, version 1.1.0, March 2011. (Incorporated by reference in § 162.920).\n(7) Phase II CORE 258: Eligibility and Benefits 270/271 Normalizing Patient Last Name Rule, version 2.1.0, March 2011. (Incorporated by reference in § 162.920).\n(8) Phase II CORE 259: Eligibility and Benefits 270/271 AAA Error Code Reporting Rule, version 2.1.0. (Incorporated by reference in § 162.920).\n(9) Phase II CORE 260: Eligibility \u0026 Benefits Data Content (270/271) Rule, version 2.1.0, March 2011. (Incorporated by reference in § 162.920).\n(10) Phase II CORE 270: Connectivity Rule, version 2.2.0, March 2011. (Incorporated by reference in § 162.920).\n(b) Excluding where the CAQH CORE rules reference and pertain to acknowledgements and CORE certification.","path":["Title 45—Public Welfare","SUBTITLE A—Department of Health and Human Services","SUBCHAPTER C—ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS","PART 162—ADMINISTRATIVE REQUIREMENTS","Subpart L—Eligibility for a Health Plan"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-45.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:21Z","sha256":"ca7316454032861450ec71aba41fb231b805318582aabde362e05504f6dd2b2a","source_id":"us-cfr","stale":true,"prev":"us/45-cfr-162.1202","next":"us/45-cfr-162.1301"},"notice":"GroundRules: Original legal text. Not legal advice."}