CAQH Initiative Moves Industry Closer to Electronic Connectivity Standard, Consortium Claims

CAQH, (Washington, D.C.), a non-profit alliance of health plans and trade associations has developed a set of voluntary business rules that the organization asserts will pave the way for providers to receive consistent electronic information about patient deductible balances from potentially any health plan at the point of care.

The rules were the result of the second phase of activities conducted by the CAQH Committee on Operating Rules for Information Exchange (CORE), a collaborative healthcare industry initiative.

CAQH launched the multi-phase program in 2005. Core focuses on improving provider access to electronic patient administrative and payer information before or at the time of service using any technology. The CORE rules build upon national standards, such as HIPAA.

The Phase II rules also cover requirements for electronic connectivity, patient identification, claims status and reporting of patient financial responsibility for an increased number of service codes included in the HIPAA standards. CORE's second set of rules builds on the rules created by the initiative during its Phase I efforts, which were completed in 2006. Both phases are advancing health plan-provider system interoperability.

More than 20 healthcare associations, accrediting bodies, networks and businesses have committed to endorsing the CORE Phase II rules.

"Today's announcement further demonstrates that CORE is transforming the way our industry communicates," said Ronald A. Williams, CAQH chairman of the board and chairman and CEO of Aetna. "With the Phase II rules now in place and work begun on Phase III, CORE is effectively achieving its mission to create an all-payer approach to streamlined administrative data exchange."

Peggy Bresnick Kendler has been a writer for 30 years. She has worked as an editor, publicist and school district technology coordinator. During the past decade, Bresnick Kendler has worked for UBM TechWeb on special financialservices technology-centered ... View Full Bio