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Last Modified: 11/11/2017 Location: FL, PR, USVI Business: Part A, Part B

First Coast Service Options, Inc. (First Coast) HTTPS CAQH CORE compliant connectivity guide

Introduction

The Secretary of the Department of Health and Human Services (HHS) named the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules (CORE) as the authoring entity of the phase I, II, and III operating rule. The operating rules are intended to provide additional direction and clarification to the electronic data interchange (EDI) standard adopted under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
This document provides information on how to connect to the First Coast JN M2 Smartxfr CAQH CORE compliant system server that supports the following two message envelope standards and message exchanges, hypertext transfer protocol & multipurpose internet mail extensions (HTTP+MIME) and simple object access protocol & web service definition language (SOAP+WSDL) message, in accordance with the CAQH CORE phase II connectivity rule 270. Go to http://www.caqh.org/pdf/CLEAN5010/270-v5010.pdf external pdf file for information on the CAQH CORE connectivity rule 270 version 2.2.0. For additional information on the CAQH CORE rules visit http://www.caqh.org/core external link.

User expectations

This document is intended for use by a technical professional or an organization that has experience implementing secure web-based connectivity. The instructions in this guide are not intended to stand alone as a sole resource.
It is solely the responsibility of the submitter or user to develop and create their CORE web services compliant client application. First Coast will not provide or support the end user client application. First Coast strongly recommends the organizations using this guide to take appropriate actions and have available technical support before attempting to enroll using the HTPPS CAQH CORE connection.
Please ensure you are using Soap Envelope Version 1.2 and SOAP Message Version 1.2. Also make sure you are using Transport Security Mode with Certificate Authentication.

Enrollment

Trading partners are required to enroll prior to attempting to connect to the First Coast JN M2 Smartxfr CAQH CORE compliant system. To access the new EDI HTPSS CAQH core connection enrollment form visit https://medicare.fcso.com/EDI_Forms/.
For more information on how to enroll for HTTPS CAQH CORE compliant connection for EDI please contact the First Coast EDI helpdesk at 888-670-0940, option 4 or via email to MedicareEDI@fcso.com.

X.509 digital certificate

The purchase of a X.509 digital certificate from a trusted certificate authority is a requirement in order to connect to the First Coast JN M2 Smartxfr CAQH CORE compliant system. The X.509 digital certificate must be recertified at intervals defined by the Certificate Authority in order to continue to access the First Coast JN M2 Smartxfr CAQH CORE compliant system. Trading Partners will need to authenticate with an X.509 digital certificate as user ID and password authentication will not be supported.
The trading partners X.509 digital certificate must be submitted to the First Coast EDI gateway Smartxfr server via secure file transfer protocol (SFTP) using a secure private network hosted by a participating network service vendor (NSV). For a list of NSV visit https://medicare.fcso.com/edi_news/276187.asp. The valid X.509 digital certificates filename extensions allowed are:
*.cer
*.crt
*.der
*.pem
If you receive a rejection on the transaction acknowledgment (TRNACK) report, please correct the issue and resubmit your certificate. If you have submitted a successful X.509 digital certificate you will not receive a TRNACK report.
TRNACK reports rejections for incomplete or missing information
Error number = 101 and severity = 1: Incomplete or missing certificate information – Serial Number
Error number = 101 and severity = 1: Incomplete or missing certificate information – Issuer DN
Error number = 101 and severity = 1: Incomplete or missing certificate information – Subject DN
Error number = 101 and severity = 1: Incomplete or missing certificate information – Start Date
Error number = 101 and severity = 1: Incomplete or missing certificate information – End Date
TRNACK report when a certificate has already been loaded to current organization
Error number = 201 and severity = 1: Duplicate - Certificate already on file for this trading partner
TRNACK report when a certificate has already been assigned to a different organization
Error number = 301 and severity = 1: Certificate linked to another trading partner
TRNACK report when a certificate is expired
Error number = 401 and severity =1: Certificate authority not approved
TRNACK report when a certificate authority is not approved
Error number = 401 and severity = 1: Certificate authority not approved – {message}
TRNACK report when a certificate is valid for more than 3 years
Error number = 501 and severity = 1: Validity period greater than 3 years
TRNACK report when a certificate is invalid for an exception
Error number = 602 and severity = 1: Certificate exception {message}
TRNACK report when a certificate is invalid, not properly formatted
Error number = 602 and severity = 1: Fail to parse input stream
Once you have submitted a successful X.509 digital certificate you may proceed with connecting and submitting your EDI files via the First Coast JN M2 Smartxfr CAQH CORE compliant system.

Connectivity URLs:

EDI Submitters connecting via SOAP will use the following link to connect, send, and receive their EDI transactions.
https://coregateway.fcso.com/CoreBatchGateway/soap/coreservice
EDI Submitters connecting via MIME will use the following link to connect, send, and receive their EDI transactions.
https://coregateway.fcso.com/CoreBatchGateway/TransactionSocketServlet

Supported transactions

The following EDI transactions are supported in batch mode.
1. Health Care Claim Status Request and Response (276/277)
2. Health Care Claim Payment Advice (835)
3. Implementation Acknowledgement for Health Care Insurance (999)

Envelope data element definitions

CAQH CORE connectivity rule 270 defines the envelope requirements and envelope metadata. These are payer specific requirements.

Element
Value
Sender ID
First Coast EDI assigned submitter ID
Received ID
FCSO
Payload ID
Unique identifier for a transaction submission. Must be unique for each transaction.
Payload Type
Reference the different EDI transaction examples in the CAQH CORE Connectivity Rule 270
A Payload ID must be included in the request to download a “RECEIVE.999” or a “RECEIVE.TA1” file, to identify the specific Ack to Retrieve. This ties the 999 and the TA1 back to the 276 they were generated from.
A Payload ID is not used to download a “RECEIVE.277_5010” or a “RECEIVE.835_5010”. When these files are requested to download via CORE, the oldest format that has not yet been retrieved is downloaded.

Client software requirements

First Coast does not support the user’s client software. Visit http://www.caqh.org/sites/default/files/core/phase-ii/policy-rules/270-v5010.pdf external pdf file for information on the CAQH CORE 270 Connectivity rule. Trading partners will need to develop the user’s client software that will communicate with the First Coast JN M2 Smartxfr CAQH CORE compliant system. The trading partner will need client software that is compliant with the CORE standards outlined on the CAQH-CORE website. First Coast cannot assist the user in developing this client software, nor does First Coast provide client software.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.