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Washington, DC,
September 14, 2006 − More than 20 leading healthcare organizations, including
Aetna, Inc.; AultCare; Blue Cross Blue Shield of North Carolina; Emdeon; Health
Net, Inc.; Health Plan of Michigan; Humana Inc.; Mayo Clinic; McKesson Provider
Technologies; Montefiore Medical Center; Siemens; and WellPoint, Inc. and its 14
Blue-licensed subsidiaries, have committed to making it significantly easier for
physicians and other health professionals to verify patient insurance
information – one of the biggest administrative challenges identified by
providers, CAQH announced today.
By March 31, 2007, these organizations will electronically exchange eligibility
and benefits information according to operating rules developed through the CAQH
Committee on Operating Rules for Information Exchange (CORE). Operating rules
build on existing standards, such as HIPAA, to make electronic transactions more
efficient, predictable and consistent, regardless of the technology.
“Today’s announcement is the first wave of an industry campaign to reduce
unnecessary administrative burden related to verifying patient insurance
coverage,” said Bob Greczyn, CAQH Board chairman and CEO and President of Blue
Cross and Blue Shield of North Carolina. “These stakeholders are taking a
revolutionary step that will help define the future of electronic communication
between health plans and providers.”
According to CAQH, a nonprofit alliance of the nation's leading health plans,
networks and trade associations working to simplify healthcare administration,
provider practice staff often spend hours researching and making follow-up calls
to obtain insurance information. The CORE operating rules will allow providers
to get the information from any participating health plan in 20 seconds or less.
Nearly 70 million Americans are covered by the health plans committed to using
the CORE Phase I rules by March 2007.
“Health plan commitment to use these standard rules is welcome news for
providers across the country,” said Spencer Foreman, M.D., president of
Montefiore Medical Center. “Eligibility verification is a cumbersome and
time-consuming but critical process. These rules should dramatically reduce the
administrative burden required to chase this important data.”
The other leading healthcare organizations that also have committed to follow
the CORE rules by the March 2007 date include the following vendors and
clearinghouses: ACS State Healthcare; Availity, LLC; athenahealth, Inc.; GHN-Online;
HTP, Inc.; MedAvant Healthcare Solutions; MedCom USA; MedData; NaviMedix Inc.;
Passport Health Communications and Quovadx, Inc.
CAQH also announced that 19 organizations are endorsing the CORE Phase I rules.
Those organizations are Accenture; the American Academy of Family Physicians;
the American College of Physicians; the California Regional Health Information
Organization; Claredi, an Ingenix Division; Edifecs, Inc.; the eHealth
Initiative; Foresight Corporation; the Greater New York Hospital Association;
the Healthcare Financial Management Association; the Healthcare Information and
Management Systems Society; the Medical Group Management Association; the
Michigan Public Health Institute; Microsoft Corporation; MultiPlan, Inc.;
Pillsbury Winthrop Shaw Pittman, LLP; the Smart Card Alliance; URAC and the
Workgroup for Electronic Data Interchange.
"Well-developed and widely used information standards are central to realizing
our national goals for better quality and efficiency,” said David J. Brailer,
M.D., Ph.D., former National Coordinator for Health Information Technology at
the U.S. Department of Health and Human Services. “The CORE standards can
simplify health care administration and improve the experience of America's
consumers at a critical time in their lives.”
CAQH launched CORE to promote health plan-provider interoperability and improve
provider access to administrative information. The voluntary industry-wide
initiative has brought together more than 85 healthcare industry stakeholders –
health plans, providers, vendors, CMS and other government agencies,
associations, regional entities, standard-setting organizations and banking
industry experts – to develop CORE’s first set of operating rules, finalized
earlier this year, which are modeled on those used to make ATM banking an
everyday occurrence.
Click for a complete list of CORE
participants.
The CORE operating rules will help providers 1) determine whether a health plan
covers the patient, 2) determine patient benefit coverage and 3) confirm
coverage of certain treatments, as well as the patient’s co-pay amount,
coinsurance level and base deductible levels (as defined in the member
contract). In addition, the rules establish policies governing the exchange of
that data, including:
* System connectivity
* Standard inquiry acknowledgements
* Maximum response times
* Minimum hours a system must be available
* Standard 270/271 companion guide flow and format
The CORE initiative will create operating rules to address additional
eligibility components and business transactions in Phase II (2006-2007) and
later phases (2007-and beyond). CAQH plans to launch the CORE Phase II operating
rules in late 2007.
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.
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