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CAQH Core Rules Final Component of HITSP Interoperability Standards Formally Recognized By HHS Sec. Leavitt

WASHINGTON, Feb. 11 /PRNewswire-USNewswire/ -- CAQH announced today that the eligibility data content section of its Committee on Operating Rules for Information Exchange (CORE) Phase I rules is a final component of the Healthcare Information Technology Standards Panel's (HITSP) first set of interoperability standards. These standards were formally recognized by Health and Human Services Secretary Mike Leavitt late last month.

This recognition means that those CORE rules, included in HITSP's Consumer Empowerment Interoperability Specifications, can be incorporated into federal agencies' healthcare programs. It also marks the start of a process through which the Certification Commission on Health Information Technology (CCHIT) can begin testing for CORE data content compliance in products it certifies. Inclusion of the CORE rules demonstrates the need for a national approach to clinical and administrative data integration, as well as HHS' intent to build upon existing market momentum to create such an approach.

"We are very pleased that the CORE Phase I rules were embraced by HITSP and recognized by Secretary Leavitt," said Robin J. Thomashauer, CAQH executive director. "This clearly shows that our industry can voluntarily make significant contributions to improving electronic healthcare data exchange at the federal level."

HITSP, a standards panel of the American National Standards Institute, was established to harmonize the hundreds of individual standards needed to create a nationwide health information network. The panel works with the Office of the National Coordinator for Health Information Technology to ensure seamless implementation of the interoperability specifications. HITSP is well underway in working on its second set of interoperability specifications and the full set of CORE Phase I rules are included in the draft Medications Management interoperability specification.

CAQH launched CORE to create an all-payer solution that gives providers access to insurance information before or at the time of service using the electronic system of their choice for any patient or health plan. The organization has brought together more than 100 industry stakeholders to collaborate on a set of uniform business rules to achieve that goal. Built upon national standards, such as HIPAA, CORE rules make electronic administrative data communications seamless, streamlined and predictable, regardless of the technology -- in many cases eliminating the need for time- consuming phone calls and paperwork.

CORE-participating stakeholders collectively cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.

To date, more than 25 leading national healthcare organizations and products have been certified by CAQH as operating in compliance with the CORE Phase I rules. Over 20 other healthcare associations, accrediting bodies, networks and businesses have endorsed the rules.

CORE's second set of rules builds on the CORE Phase I rules and adds others related to patient identifiers, patient accumulators, claims status and connectivity. Phase II also will require patient financial responsibility reporting 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, facilitate administrative healthcare information exchange and encourage administrative and clinical data integration. Visit for more information.

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