"CORE is building a milestone-driven path for industry coordination on electronic administrative data exchange," said Bruce Goodman, senior vice president and chief service and information officer for Humana. "We believe the CORE rules are a critical component for moving our organization and the entire industry toward a more efficient, understandable health care system."
Availity, LLC, a clearinghouse and health information network partially owned by Humana, also is certified as operating in accordance with the CORE Phase I rules.
To date, CORE has created and promulgated two phases of rules. The Phase I rules ensure that health plans and providers share accurate and consistent eligibility and benefit information. CORE Phase II rules build on the Phase I rules, adding guidelines covering electronic connectivity, patient identifiers, claims status and reporting of patient financial responsibility.
CORE participants have begun the process to develop Phase III rules, which will focus on improving the electronic exchange of additional administrative transactions, such as prior authorization and remittance advice.
CAQH, a nonprofit alliance of health plans and trade associations, serves as 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.
Humana Inc., headquartered in Louisville, Kentucky,
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