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MD On-Line Achieves CAQH CORE(TM) Certification for Consistent Healthcare Administrative Data Exchange
Date:7/29/2008

collected provides co-pay and benefit information allowing the provider to collect co-pay amounts at the point of service.

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, the CORE rules eliminate 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.

CAQH, a nonprofit alliance of health plans, trade associations and networks, launched CORE to promote health plan-provider interoperability and improve provider access to administrative information. To date, the voluntary industry-wide initiative has brought together more than 100 healthcare industry stakeholders -- health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and banking industry experts -- to develop the operating rules. These stakeholders cover more than 130 million lives, or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.

"The CORE rules represent a cutting-edge approach to improve provider access to consistent eligibility and benefits data," said Robin J. Thomashauer, CAQH executive director. "By adopting the rules and completing CORE certification, MD On-Line is reducing unnecessary healthcare administrative burden, and helping U.S. healthcare become more efficient and responsive to patient concerns."

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