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Edifecs, CAQH and Harvard Pilgrim Health Care Will Examine CORE Phase II Testing Outcomes and Lessons Learned at HIMSS09 Interoperability Showcase

Harvard Pilgrim achieves CORE Phase II Testing Certification with Edifecs CORE Testing Service - includes compliance with rules that are now required in X12 Version 5010

BELLEVUE, Wash., April 5 /PRNewswire/ -- Edifecs announced today that it will, together with its partners CAQH and Harvard Pilgrim Health Care, examine the outcomes and lessons learned from the CORE Phase II Certification testing including elements of the newly mandated 5010 Rules, in a presentation at the HIMSS09 Interoperability Showcase, on Tuesday, April 7, 11:15 AM - 11:45 AM (CT).

The HIMSS09 Interoperability Showcase has become an internationally recognized forum for highlighting the Integrating the Healthcare Enterprise's (IHE) common framework for delivering interoperability across local, regional, and national health information exchanges. It features advanced technology and standards in an interactive environment using test scenarios that simulate how health information is seamlessly passed across the full continuum of care.

Throughout the conference CAQH CORE and Edifecs will be available (Booth #7750, McCormick Place, North Hall) to demonstrate the Edifecs CORE Testing Service and Harvard Pilgrim will be conducting live transmissions of CORE Phase II Certified Eligibility & Benefits Inquiry and Response 270/271 transactions that incorporate aspects of the 5010 standards. "This collaborative demonstration will showcase how Harvard Pilgrim, being the 1st certified adopter of the CORE Phase II rules, is already realizing benefits from now mandated 5010 standards by using the CORE operating rules. By being the first adopter of the CORE Phase II rules Harvard Pilgrim is producing real-world results that will have a long-term, positive impact on healthcare administration," said Sunny Singh, CEO at Edifecs.

Of equal or possibly greater importance is the fact that the demonstration will be accomplished using the CORE II connectivity standard - a web services based process using digital certificates to secure the transactions over the internet. "We've been using a web services protocol regionally for the past four years to exchange millions of transactions in our market. With the evolution to a national standard for secure transport of health care information via the internet, CAQH's CORE, in conjunction with HITSP, have in effect offered a solution to make health information exchange as easy as email," said John Kelly, Director for eBusiness Architecture at Harvard Pilgrim.

Initiated by CAQH CORE supports a nationwide drive to provide patient information electronically, ideally before services are performed, or at time of service. Improving provider access to administrative and payer-specific information is one of the underlying goals of CORE, as well as creating interoperability among parties based on technical platforms that are both vendor and technology neutral. Therefore participants are able to exchange data with any technology and applications they select.

Built and maintained by Edifecs, the Edifecs CORE Testing Service validates implementation of the CORE rules, using scripts and test data developed by the CORE Work Groups, which consist of providers, payers, clearinghouses, government payers and other healthcare stakeholders, and approved by the CORE participants via voting. Edifecs, HPHC and CAQH staff will specifically address two issues of great potential for the Payer and Provider communities operating with the CORE Phase I and Phase II Rules:

  1. Patient Financials: The panel will demonstrate the return of patient financial information that has been included in the voluntary CORE requirements since April 2006 - well ahead of the recommendations in the mandated 5010. The CORE rules, using standards, specify the following be exchanged: co-pay, co-insurance, static and remaining deductible as well as "In Network" and "Out of Network" variances.
  2. CORE Connectivity: Incorporated into aspects of HITSP Interoperability Specifications, CORE Connectivity is paving the way for the increased access to administrative data and compatibility between administrative and clinical data exchange. Adoption of a connectivity standard by payers, vendors and industry-wide initiatives is critical to making e-Health a reality.

Entities must complete a testing process leveraging Edifecs CORE-authorized Phase I and or CORE Phase II Certification testing product.. This service confirms that an organization's batch and/or online real-time systems and applications comply with the CORE Phase I and Phase II rules. Phase I certification is required prior to completing Phase II certification, however the Edifecs CORE testing product now allows for entities to complete Phase I and II certification testing during a single, integrated process.

About Edifecs, Inc.

Edifecs helps organizations achieve interoperability and return on investment by simplifying the adoption of standard electronic transactions and deriving business value from trading partner communities. 2009 marks 14 years of Edifecs' expertise in providing innovative technology solutions to over 1000 clients worldwide. Founded in 1996, Edifecs is headquartered in Bellevue, WA. Company website: Contact: Kevin Pierce, 425-452-0622,

About Harvard Pilgrim Health Care

Harvard Pilgrim Health Care is a not-for-profit health plan that provides a variety of insurance plan options and self-funding arrangements to more than one million members in Massachusetts, New Hampshire and Maine. Harvard Pilgrim provides innovative approaches to health improvement and disease management, unique online tools that speed and simplify key transactions for employers and providers and personalized health support at

About CAQH

CAQH, a nonprofit alliance of health plans and trade associations, is a catalyst for healthcare industry collaboration on initiatives that streamline healthcare administration, resulting in a better care experience for patients and caregivers. CAQH solutions - like CORE - help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration and encourage administrative-clinical data integration. More than 100 healthcare industry stakeholders are collaborating on CORE.

Participating health plans cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries. Over 35 health plans, large provider groups and health IT products are Phase I CORE-certified and committed to Phase II certification. Visit for more information.


The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore and other locations across the United States and Europe, HIMSS represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care. Visit for more information.

CORE Certification

Edifecs has been selected as an authorized CORE certification testing vendor by CAQH. The Edifecs CORE testing service will allow entities interested in becoming certified by CAQH to perform the requirements necessary to show compliance with all of the CORE Rules. CORE Phase I and Phase II Certification are available for providers, health plans, clearinghouses and vendors. For more information, visit CAQH's CORE website at

SOURCE Edifecs, Inc.
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