CAQH AUTHORIZES EDIFECS TO CERTIFY HEALTHCARE ORGANIZATIONS TO PARTICIPATE IN ITS CORE ELIGIBILITY AND BENEFITS VERIFICATION INITIATIVE

WASHINGTON, DC - 8/16/06

After an extensive evaluation process, CAQH announced today that it has authorized Edifecs to certify that healthcare organizations’ IT systems are in compliance with its Committee on Operating Rules for Information Exchange (CORE) Phase I rules.

CAQH launched CORE in January 2005 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 more than 85 industry stakeholders - health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and banking industry experts. The participating plans represent almost 75 percent of the commercially insured, plus Medicare and some Medicaid beneficiaries.

These organizations are voluntarily collaborating on a set of operating rules modeled on those used to facilitate ATM banking to

  • Enhance interoperability between providers and payers
  • Streamline eligibility and benefits data transactions
  • Reduce the amount of time and resources providers spend on administrative functions - time better spent with patients

"Based on a rigorous evaluation process, Edifecs demonstrated that they are very capable of conducting CORE’s certification testing requirements. We are delighted to be working with Edifecs as partners in this unprecedented effort to bring true interoperability to healthcare administrative data transactions,” said Harry L. Reynolds, chair of the CAQH’s CORE Steering Committee and vice president at Blue Cross and Blue Shield of North Carolina. “Moreover, in October, we expect to announce that another vendor has been authorized by CORE to perform CORE certification testing.”

As a CORE-authorized certification testing vendor, Edifecs will test any health plan, clearinghouse, vendor and provider that is interested in applying for CORE certification against the CORE-developed, stakeholder-specific test scripts associated with each CORE Phase I rule. Entities certified as CORE compliant by Edifecs may then apply to CAQH for a CORE Seal, which they can publicly display to demonstrate both their ability to meet the CORE rules and their commitment to the CORE vision. L

“Edifecs is extremely proud to partner with CAQH, an organization that is streamlining patient eligibility and benefits verification by building on existing standards to make electronic transactions more predictable and consistent, regardless of the technology,” said Sunny Singh, CEO of Edifecs, Inc. CORE will address additional eligibility components and business transactions in its Phase II (2006-2007) and later phases (2007-and beyond). For more information about CORE, visit www.caqh.org.

About CAQH
CAQH (www.caqh.org) is a nonprofit alliance of health plans and trade associations. It serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. 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.

About Edifecs, Inc.
Edifecs, Inc. (www.edifecs.com) helps organizations achieve interoperability and dramatic return on investment by enabling, managing and deriving business value from standard electronic transactions within trading partner communities.

Edifecs products include the Edifecs Healthcare Suite–a set of powerful applications and technologies that reduce friction in the administrative, clinical, financial and pharmaceutical transaction workflows, both within and between healthcare enterprises. The Suite includes business performance management applications that automate and manage the full lifecycle of transactions; from community enablement, to testing and data validation, real-time transaction monitoring, claim repair and reconciliation, facilitating direct connectivity and providing rich transaction analytics.

Contact:
CAQH
Chris McNamara
(202) 778-3271

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