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Study Results Show CAQH CORE Certification Dramatically Cuts Administrative Costs, Accelerates I.T. Adoption by Providers and Health Plans
Date:6/2/2009

Industry-wide Implementation Could Yield $3 Billion of Savings in Three Years

WASHINGTON, June 2 /PRNewswire/ -- CAQH(R) announced today that a study of results achieved by health care providers and health plans using the Phase I rules of its Committee on Operating Rules for Information Exchange(R) (CORE) showed dramatic cost savings, accelerated use of real-time electronic transactions, improved claims verifications and reduced claims denials.

The findings confirm the value of using national standards for streamlined administrative data exchange as a key component of creating a national ehealth solution, which is a priority of the $20 billion in designated stimulus funding for health I.T.

Based on results from the study, the estimated potential savings from an industry-wide implementation of the CORE Phase I rules are more than $3 billion in three years. These savings could grow exponentially as additional phases of CORE rules are implemented.

"As the federal stimulus seeks to be a catalyst to fund workable health I.T. solutions that benefit all stakeholders, CORE is a model for the real results that can be achieved by streamlining routine administrative tasks and promoting interoperability," said Ronald A. Williams, Chairman and Chief Executive Officer of Aetna, Inc., an early adopter of CORE. "The results demonstrate that CORE is a practical solution that is already paying dividends."

Conducted for CAQH by IBM's Global Business Services, the study assessed six CORE-certified health plans that represent 33 million covered lives (Aetna, AultCare, BlueCross BlueShield of North Carolina, BlueCross BlueShield of Tennessee, Health Net, and WellPoint affiliated health plans), as well as leading provider groups and vendors using the CORE Phase I rules. Key findings of the study show:

  • Electronic insurance eligibility verifications took ap
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SOURCE CAQH
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