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CAQH Core Rules Final Component of HITSP Interoperability Standards Formally Recognized By HHS Sec. Leavitt
Date:2/11/2008

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 exch
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