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Washington, DC, April 3,
2007 − Healthcare providers and hospitals can now access in seconds consistent
eligibility and benefits information required to verify patient health insurance
coverage thanks to new standard business rules developed by the CAQH Committee
on Operating Rules for Information Exchange (CORE).
Currently, provider practice staffs often spend hours researching and making
follow-up calls at significant cost to obtain and verify insurance information.
The CORE rules, which build on the HIPAA eligibility (X12 270/271) transaction,
make electronic administrative data communications seamless, streamlined and
predictable, regardless of the technology – in many cases eliminating the need
for practice staff phone calls.
This significant improvement was made possible because nearly 20 leading health
organizations have begun voluntarily exchanging patient administrative data in
accordance with the CORE rules. Those organizations are ACS EDI Gateway, Inc.;
Aetna, Inc.; athenahealth, Inc.; AultCare Corporation; Emdeon Business Services;
Emerging Health Information Technology; Health Net; HTP, Inc.; Mayo Clinic;
McKesson Provider Technologies; MedAvant Healthcare Solutions; Medical
Informatics Engineering, Inc. (MIE); Montefiore Medical Center; NaviMedix, Inc.;
Passport Health Communications; Siemens Medical Solutions; and WellPoint, Inc.
and its 14 Blue Cross and Blue Shield-licensed subsidiaries.
All of these organizations recently completed CORE certification testing, a
process ensuring that their IT systems and products comply with the CORE rules.
They join The SSI Group, Inc., which was the first healthcare organization to
receive CORE certification seals. More than 50 million Americans are covered by
the health plans now using the CORE rules.
“Quick access to reliable patient insurance information eliminates a huge
administrative headache for all healthcare providers,” said William F. Jessee,
M.D., FACMPE, FACPM, President and Chief Executive Officer of the Medical Group
Management Association. “All of the CORE-certified organizations and those
seeking certification are to be applauded for taking a bold step to fix an
age-old problem.”
CAQH launched CORE to simplify eligibility and benefits data transactions,
promote better health plan/provider interoperability and improve provider access
to administrative information. CORE’s vision is provider access to eligibility
and benefits information before or at the time of service using the electronic
system of their choice for any patient or health plan, effectively reducing
administrative burden and costs. To date, the voluntary industry-wide CAQH
initiative has brought together nearly 100 industry stakeholders – health plans,
providers, vendors, CMS and other government agencies, associations, regional
entities, standard-setting organizations and other healthcare entities – to
collaborate on the rules.
“Interoperability should be at the heart of any long-term solution for improving
healthcare administration,” said Bob Greczyn, CAQH Board chairman and Blue Cross
and Blue Shield of North Carolina President and CEO. “The CORE rules are a
revolutionary step toward that goal. They are a foundation and model for all
health plan/provider electronic administrative communications.”
Several other healthcare entities, including Blue Cross and Blue Shield of North
Carolina; Blue Cross and Blue Shield of Tennessee; GHN-Online; Health Plan of
Michigan; MedData; NoMoreClipboard.com; the U.S. Department of Veterans Affairs;
and VisionShare, Inc. are committed to CORE rules compliance by no later than
June 30, 2007.
“Today’s announcement is the product of a unique collaboration in healthcare
administration,” added Jay Gellert, Health Net, Inc. President and CEO, and
Chair of the CAQH Administrative Simplification Committee. “Adoption of the CORE
rules by these pioneering organizations proves that the industry is actively
contributing ground-breaking solutions. We encourage all organizations with an
interest in insurance verification to pursue CORE certification as soon as
possible.”
The CORE rules were recently included in the Health Information Technology
Standards Panel (HITSP) Consumer Empowerment Interoperability Specifications as
part of a national model for populating and maintaining robust patient insurance
information in patients’ personal health records. CORE’s second set of rules,
expected to be announced later this year, will address additional eligibility
components (X12 270/271) and claims status (X12 276/277), both of which are
addressed under HIPAA.
More than 20 organizations have endorsed the CORE rules, including Accenture,
the American Academy of Family Physicians; the American College of Physicians;
the American Health Information Management Association; CalRHIO; Claredi, an
Ingenix Division; Edifecs, Inc.; the eHealth Initiative; Foresight Corp.; the
Greater New York Hospital Association; the Healthcare Financial Management
Association; the Healthcare Information and Management Systems Society; the
Medical Group Management Association; Michigan Public Health Institute;
Microsoft Corporation; MultiPlan, Inc.; NACHA - The Electronic Payments
Association; Pillsbury Winthrop Shaw Pittman, LLP; the International Smart Card
Alliance Council; URAC and the Workgroup for Electronic Data Interchange.
About CAQH
CAQH is a catalyst for healthcare industry collaboration on initiatives that
simplify and streamline healthcare administration. 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. |
