BlueCross BlueShield of Tennessee Achieves CAQH CORE Phase II Certification

Increased Adoption of Administrative Data Exchange and Interoperability Rules Enhance Service for 3 Million Members

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Jun 24, 2010, 08:00 ET

WASHINGTON, June 24 /PRNewswire/ -- CAQH® announced today that BlueCross BlueShield of Tennessee (BCBST) has achieved certification for its implementation of the CAQH Committee on Operating Rules for Information Exchange® (CORE®) Phase II rules. The certification will benefit more than 3 million insured members of the Tennessee health plan.

BCBST is the latest healthcare organization to be awarded a Phase II Seal for its voluntary adoption of business rules being developed by CORE, a multi-phase initiative of CAQH. The CORE rules are streamlining the exchange of administrative data, 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 the CORE rules, which address both infrastructure and data content.

"This accomplishment underscores the commitment by our industry and our company to transform the way healthcare data is exchanged through technology," said Vicky Gregg, BCBST president and CEO and a CAQH board member. "A phased approach to collaboratively define and drive adoption of policies and operating rules moves healthcare closer to achieving interoperability while improving the individual patient experience."

"Specifically, the CORE Phase II rules further improve administrative efficiency for our network providers, reduce costs and free up time for physicians and their staff to focus on patients."

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. These rules build upon Phase I, which covers eligibility and benefits data. Both phases align with Federal interoperability efforts.

"We are pleased that BCBST is CORE Phase II certified, as this will improve the flow of administrative information between us," said Jerry L. Miller, M.D., founder of Holston Medical Group. "CORE brings new efficiencies to sharing patient coverage data and helps streamline administrative processes overall."

CORE participants are finalizing the requirements of Phase III, which will include operating rules 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.

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 150 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 in three years. 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