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Health IT Vendors, Clearinghouses Transforming Patient Insurance Verification Through CAQH National Initiative

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), 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 that create, send or transmit healthcare administrative data, including eligibility and benefits information -- health plans, large provider groups, clearinghouses and vendors. Organizations that do not create, send or transmit data can demonstrate their support for CORE's mission and the Phase I rules by applying for a CORE Endorser Seal.

More than 25 healthcare organizations (, covering approximately 65 million or one-third of U.S. commercially insured lives, are now CAQH CORE-certified. Over 20 other healthcare associations, accrediting bodies, networks and businesses have endorsed the rules.

"CORE is leading the way to efficient consistent provider access to patient health information which is critical in today's healthcare arena," said Julie Klapstein, CEO of Availity, LLC.

CAQH launched CORE to simplify eligibility and benefits data transactions, promote better health plan/provider interoperability and improve provider access to administrative information. CORE's vision is provider access to eligibility and benefits information before or at the time of service using the electronic system of their choice for any patient or health plan, effectively reducing administrative burden and costs. To date, the voluntary industry-wide CAQH initiative has brought together more than 100 industry stakeholders ( -- health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and other healthcare entities -- to collaborate on the rules.

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

The Initiative's second set of rules, expected to be announced early in 2008, are aimed at bringing greater administrative efficiency to healthcare data transactions involving additional eligibility components (X12 270/271) and claims status (X12 276/277).

About CAQH

CAQH is 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 for more information.

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