CORE Overview

CAQH launched the Committee on Operating Rules for Information Exchange (CORE) with the vision of giving providers 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.

CORE is more than 130 industry stakeholders – health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and other healthcare entities. CORE participants maintain eligibility and benefits data for more than 150 million commercially insured lives plus Medicare and Medicaid beneficiaries. Working in collaboration they are building consensus on a set of operating rules that will:

1. Enhance interoperability between providers and payers
2. Streamline eligibility, benefits, and claim data transactions
3. Reduce the amount of time and resources providers spend on administrative functions – time better spent with patients.

CORE is tracking and has published metrics regarding rule impact to help quantify participant return on investment.

Operating rules build on existing standards to make electronic transactions more predictable and consistent, regardless of the technology. Rights and responsibilities of all parties, security, transmission standards and formats, response time standards, liabilities, exception processing, error resolution and more must be clearly defined in order to facilitate successful interoperability. Beyond reducing cost and administrative hassles, operating rules foster trust among all participants.

Click here to view the full-page CAQH CORE Wall Street Journal ad from Spring 2009.