Navigation Links
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 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 (http://www.caqh.org/CORE_pending.php), 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 (http://www.caqh.org/ben_participating.php) -- 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 (http://www.caqh.org/ben_participating.php) 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 http://www.caqh.org for more information.


'/>"/>
SOURCE CAQH
Copyright©2007 PR Newswire.
All rights reserved

Related medicine news :

1. Poor health care in Russia maybe causing Decline in its Population
2. Startling Expose – Physicians Often Have No Regular Source Of Health Car
3. Debate Rages over firing of HIV infected health care workers
4. Want a Healthy brew? Have some Tea!
5. Patient’s perception of health status helps in better recover
6. Antioxidants protect health tissue in people undergoing radiation therapy.
7. Sexual abuse affect health for a lifetime
8. Smoking a greater risk than HIV? Yes say health experts!!!!
9. Healthcare sector is now a multi billion-dollar industry in India
10. Exclusive breast-feeding advised for six months in infants recommends World Health Organization
11. How much can exercise improve health?
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... , ... The American Board of Family Medicine's (ABFM) Board of Directors has ... succeeding Dr. James C. Puffer upon his retirement. Dr. Newton will serve in the ... at the end of 2018. Upon assuming the role of President and CEO on ...
(Date:10/13/2017)... , ... October 13, 2017 ... ... of Pharmacy (SOP) alumni Hannah Randall, PharmD ‘17, and Jennifer Huggins, PharmD ... on guideline updates for the primary prevention of cardiovascular diseases during the ...
(Date:10/13/2017)... Calif. (PRWEB) , ... October 13, 2017 , ... Many ... dementia. However, many long-term care insurance companies have a waiver for care if the ... 90-day elimination period, when the family pays for care, is often waived, so the ...
(Date:10/13/2017)... ... October 13, 2017 , ... Global Healthcare Management’s 4th ... Park in Milford, NJ. This free event, sponsored by Global Healthcare Management’s CEO, ... The fun run is geared towards children of all ages; it is a non-competitive, ...
(Date:10/13/2017)... ... October 13, 2017 , ... Coveros, a leader ... been awarded a contract by the Center for Medicare and Medicaid Services (CMS). ... the enterprise use of Agile methodologies in a consistent and high value manner ...
Breaking Medicine News(10 mins):
(Date:9/19/2017)... 19, 2017 HistoSonics, Inc., a venture-backed medical device company developing a non-invasive, robotically ... announced three leadership team developments today:   ... ... Tom ... Veteran medical device executive Josh Stopek , PhD, who ...
(Date:9/18/2017)... Sept. 18, 2017 EpiVax, Inc. ... bioinformatics and immune engineering, today announced a ... A (H7N9) vaccine. ... seasonal influenza and presents a challenge for ... exposure to be effective. Using state-of-the-art bioinformatics and ...
(Date:9/12/2017)... N.J. , Sept. 12, 2017  Consumer reviews on the ... Hearing as the number one company for hearing aids, ranking ... and fifteen other brands. ... Embrace Hearing Named #1 by Consumers For Hearing Aids ... Embrace Hearing is an online store that provides high ...
Breaking Medicine Technology: