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Health IT Vendors, Clearinghouses Transforming Patient Insurance Verification Through CAQH National Initiative
Date:10/16/2007

WASHINGTON, Oct. 16 /PRNewswire-USNewswire/ -- CAQH announced today that four leading healthcare technology vendors and clearinghouses have joined its national initiative working to significantly simplify patient insurance verification in provider offices.

Products or services offered by Availity, GE Healthcare, Health Management Systems and MedData are now certified in compliance with business rules developed by the CAQH Committee on Operating Rules for Information Exchange (CORE), http://www.caqh.org/CORE/. As a result, providers using these products and services can access in seconds consistent eligibility and benefits information.

The CORE rules, which build upon national standards, including HIPAA's eligibility (X12 270/271) transaction, 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.

According to a recent CAQH study, 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 could achieve significant labor savings, as the study showed that average labor costs per phone call are $1.38 vs. $0.00 for an automated transaction.

"Health IT vendors and clearinghouses are key to the backbone of electronic healthcare data exchange," said Harry L. Reynolds, CORE chair and vice president at Blue Cross and Blue Shield of North Carolina. "These organizations are now part of a groundbreaking effort that is promoting provider-health plan system interoperability.

"We encourage all organizations with an interest in reducing administrative burden to join these leaders in becoming CORE-certified."

CAQH awards CORE-certification Seals to four types of organizations
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SOURCE CAQH
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