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CAQH Authorizes Claredi Certification Testing Solution from Ingenix to Confirm CORE Eligibility and Benefits Verification Initiative Rules Compliance
WASHINGTON, DC - 12/14/06–
CAQH today announced it has authorized the Claredi certification testing solution from Ingenix for confirming that healthcare organizations’ IT systems and IT vendor products comply with Committee on Operating Rules for Information Exchange (CORE) Phase I rules.
CAQH launched the CORE initiative to promote interoperability and improve provider 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 comprised of nearly 100 healthcare industry stakeholders. Participating plans cover over 130 million commercially insured lives plus Medicare and some Medicaid beneficiaries. These organizations collaborated to develop CORE’s first set of operating rules, which were finalized earlier this year.
“Testing to verify ongoing systems compliance is one of the most critical steps in the CORE certification process,” said Jay Eisenstock, Chair of the CORE Certification/Testing Subgroup, a manager of Provider eServices for Aetna, Inc., a CORE participating organization. “The Claredi certification testing product stood up to a rigorous CORE evaluation process. We’re pleased that interested organizations are now able to turn to Ingenix to demonstrate their compliance with the CORE Phase I rules.”
As a CORE-authorized certification testing vendor, Ingenix, through its Claredi product, will test any health plan, clearinghouse, vendor or provider that is interested in applying for CORE certification against stakeholder-specific requirements. Entities certified as CORE-compliant by Ingenix may then apply to CAQH for a CORE Seal, which they can publicly display to demonstrate both their ability to meet the Phase I rules and their commitment to the CORE vision.
In September, CAQH announced that 20 leading healthcare organizations had committed to begin exchanging electronic data according to the CORE Phase I rules by March 2007 and another 20 organizations are endorsing the use of the rules. Since then, eight additional entities have stated their intention to become CORE certified.
CAQH named Edifecs as a CORE-authorized testing vendor in August.
“Because Ingenix is dedicated to delivering the benefits of real-world interoperability to healthcare, partnering with CORE to verify Phase I rules compliance is a natural extension of our business,” said Kepa Zubeldia, M.D., founder of Claredi Corporation and current senior vice president of interoperability technologies at Ingenix. “We look forward to playing a key role in this revolutionary communications initiative.”
The CORE Phase I rules will help providers verify 1) whether a health plan covers the patient, 2) whether certain services are covered by the health plan, and 3) the patient’s co-pay, coinsurance and base deductible amounts (as defined in the member contract). In addition, the rules establish policies governing the exchange of that data, including:
- System connectivity
- Standard inquiry acknowledgements
- Maximum response times
- Minimum hours a system must be available
- Standard 270/271 companion guide flow and format
CORE will address additional eligibility components and business transactions in its Phase II (2006-2007) and later phases (2007-and beyond).
CAQH is a catalyst for healthcare industry collaboration on initiatives that simplify and streamline healthcare administration. CAQH solutions help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration, facilitate administrative healthcare information exchange and encourage administrative and clinical data integration. Visit www.caqh.org for more information.
Ingenix, a wholly-owned subsidiary of UnitedHealth Group (NYSE: UNH), provides products and services to a diverse customer base within the health care community. Organizations rely on its innovative technology to improve the delivery and operations of their business. More information about Ingenix and its products and services can be obtained at http://www.ingenix.com. Ingenix acquired Claredi Corporation, the pioneer in health care transaction certification under HIPAA, in May 2006. More information about Claredi CORE testing is available at https://core.claredi.com.
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