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Aetna Requires CAQH Core Rules Certification for Vendors
Date:2/13/2008

gs from a 2006 CAQH study < http://www.caqh.org/pdf/corepidsexsumm.pdf > showed that providers may reduce labor costs associated with verifying insurance coverage as much as 50 percent by moving from labor-intensive verification methods (web, fax and phone) to automated HIPAA transactions. Health plans also can achieve significant labor savings, as the study showed that average labor costs per phone call are $1.38 versus $0.00 for an automated transaction.

Currently, more than 25 leading national healthcare organizations, including Aetna, are CORE-certified and can exchange select eligibility and benefits information with providers in compliance with the CORE Phase I rules < http://www.caqh.org/CORE_phase1.php >. Those organizations cover approximately 65 million or one-third of commercially insured lives in the U.S. Over 20 other healthcare associations, accrediting bodies, networks and businesses have endorsed the rules.

CORE's second set of rules builds on the Phase I rules, with additional guidelines for patient identifiers, patient accumulators, claims status and connectivity. The Phase II rules also require reporting of patient financial responsibility for an increased number of service codes. CAQH expects to announce Phase II certifications beginning at the end of Q3 2008 and into 2009. CORE Phase III will focus on improving the electronic delivery of additional administrative transactions, such as prior authorization.

About CAQH

CAQH is 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, faci
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