20 Healthcare Organizations Set to Achieve CAQH Core Phase II Rules Certification

Increased Adoption of Enhanced Administrative Data Exchange and Interoperability Rules Expected to Generate Continuous Stepwise Savings

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CAQH

Apr 15, 2010, 09:56 ET

WASHINGTON, April 15 /PRNewswire/ -- CAQH® announced today that twenty health plans, clearinghouses, providers and health information technology vendors have achieved or will certify their implementation of the CAQH Committee on Operating Rules for Information Exchange® (CORE) Phase II rules. Recently, six organizations joined CORE as participants, three others have endorsed and another four achieved Phase I certification.

This accomplishment is the result of the widespread voluntary adoption of business rules being developed by CORE. The CORE rules are streamlining the exchange of administrative data, which is resulting in improved access to coverage and financial information by providers at the point-of-care. Certified organizations complete a testing process to confirm that their systems or products comply with both the CORE infrastructure and data content rules.

The Phase II rules address requirements for electronic connectivity and digital certificates, patient identification, real-time claims status and reporting of year-to-date deductibles. Each phase is designed to build upon earlier phases and is aligned with Federal interoperability efforts.

The organizations that have achieved CORE Phase II certification include health plans collectively serving more than 53 million lives: Aetna; AultCare; Harvard Pilgrim Health Care; WellPoint, Inc. and its affiliated health plans in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin. Clearinghouse and health information technology vendors accomplishing CORE Phase II certification are ACS EDI Gateway, Inc.; athenahealth, Inc.; Availity, LLC; Capario; Emdeon Inc.; eServices Group Inc.; InstaMed; NaviNet, Inc.; Post-N-Track Corporation; RelayHealth; and Siemens/HDX. AvMed Health Plans; Gateway EDI; Medical Present Value, Inc. (MPV); and Office Ally recently achieved CORE Phase I certification. These organizations are now applying the CORE rules to all of their transaction-based work.

A number of entities are in the process of completing their CORE testing and will be certified in the coming weeks, including CIGNA; CSC; Mayo Clinic; Passport Health Communications Inc.; The SSI Group, Inc.; and Surescripts. Several others, like UnitedHealth Group, are also committed to achieving CORE Phase I and II certification and are in the development process.

"AultCare believes the CORE rules are a critical component for increased efficiency in our vertically integrated health system and for improving the quality of care for our community," said Rick L. Haines, president and CEO of AultCare, and CAQH board member. "This is one aspect of our commitment to increase efficiency and quality, by helping our providers get access to the information they need to make the best healthcare decisions."

Several other organizations recently decided to join the multi-phase effort to develop the next set of the CORE rules. New participating organizations include: Arizona Health Care Cost Containment System, the Medicaid agency of Arizona; Cognizant; Highmark Inc.; Payformance Corporation; the Texas Medical Association; and the Washington State Office of the Insurance Commissioner. New CORE Phase I and II endorsers include Cognizant, Health IT Conformance and Certification Organization, and HIPAA QA, Inc.

"The CORE Phase II rules dramatically improve our operational efficiency, reduce costs and free up time so we can focus on our patients," said Oscar W. Brown III, M.D., chair, Council on Socioeconomics, Texas Medical Association. "They help connect our practice with a variety of payers -- public and private -- to get the real-time data needed to make our patient eligibility and related financial transactions simple and easy."

Participants are finalizing the requirements of CORE Phase III. The operating rules will include details for infrastructure that supports referral requests and remittance advice, claims history availability, claim status content and acknowledgements, ID card specifications, and expanded eligibility and financial reporting. All are designed to make it easier for physicians and their staff to conduct administrative transactions with health plans, hospitals and other healthcare delivery organizations.

About the Committee on Operating Rules for Information Exchange® (CORE)

CAQH launched CORE, a multi-phase, collaborative healthcare industry initiative five years ago. CORE is focused on improving provider access to electronic patient administrative and payer information before or at the time of service, using any technology. The CORE rules build upon national standards, such as HIPAA. Each phase expands the available data criteria and augments the functional requirements for electronic data exchange.

CAQH has convened more than 115 healthcare industry stakeholders as participants in developing the CORE rules. Participating health plans cover more than 130 million lives or approximately 75 percent of the commercially insured plus Medicare and state-based Medicaid membership.

A study by IBM Global Business Services found that industry-wide implementation of the CORE Phase I rules alone could yield $3 billion in healthcare savings. Widespread adoption of the Phase II rules and subsequent phases of CORE will result in even greater savings throughout the healthcare industry. View www.caqh.org/CORE_overview.php for more information.

About CAQH®

CAQH serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. CAQH solutions help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration, facilitate administrative healthcare information exchange and encourage administrative and clinical data integration. Visit www.caqh.org for more information.

SOURCE CAQH