CAQH CORE LAUNCHES TRANSITION COMMITTEE TO RECOMMEND PLAN FOR MULTI-STAKEHOLDER GOVERNANCE

Change to Drive Expanded Participation and Support Shift to Mandated Environment for Operating Rules Development

WASHINGTON, DC - 4/25/11

CAQH® today announced that a Transition Committee has been launched to make recommendations regarding multi-stakeholder governance of the Committee on Operating Rules for Information Exchange® (CORE®). The Transition Committee was formed as part of a 2010 commitment made by the CAQH board to increase industry participation in operating rules development and adoption. The Committee is charged to develop a three-year governance plan that outlines structure and revenue models for CORE. It is anticipated that the Committee will complete its work and implement its recommendations by the fourth quarter of 2011.

Since 2005, the goal of CAQH CORE has been to improve provider access to administrative information before or at the time of service, using the electronic system of the provider’s choice for any patient or health plan. CORE participants have finalized two sets of operating rules that are streamlining administrative exchanges. These rules have been voluntarily adopted by a wide range of leading industry organizations. An independent study shows that becoming certified for adopting the CORE rules results in documented return on investment.

“The current CORE governance model and multi-stakeholder collaboration is guiding the voluntary operating rule-writing process today. However, to support the changing environment in which operating rules are mandatory, the Committee will make recommendations to broaden multi-stakeholder governance and engagement,” said Linda Fishman, Senior Vice President for Public Policy at the American Hospital Association and a member of the Transition Committee. “This change is critical to the CORE goal of aligning clinical and administrative simplification objectives. Most important though, is that broadening the perspectives at the table will help ensure that the operating rules reduce administrative costs for all and improve the workability of administrative processes for everyone. And the greater the standardization of processing, the easier it will be to achieve interoperability, especially as we move into an era of ever-increasing accountability.”

While outlining governance and revenue models, the Committee will preserve the CORE integrated approach to rule-writing, certification, outreach and education. Additionally, the Committee will reinforce the CORE commitment to support the operating rules mandate of the Administrative Simplification requirements outlined in Section 1104 of the Patient Protection and Affordable Care Act (ACA). In doing so, the Committee will propose ideas for enhancing the current CORE multi-stakeholder approach to increase participation by states, physicians, hospitals and other healthcare providers.

The CORE Transition Committee members represent various stakeholder groups and include senior-level executives from the following organizations:

  • Allscripts
  • America’s Health Insurance Plans (AHIP)
  • American Hospital Association (AHA)
  • American Medical Association (AMA)
  • Blue Cross and Blue Shield of North Carolina
  • GE Healthcare
  • J.P. Morgan
  • Medical Group Management Association (MGMA)
  • Minnesota Department of Health
  • Montefiore Medical Center
  • National Governors Association (NGA)
  • UnitedHealthcare
  • WellPoint, Inc.

More details about representatives and the Committee, which is being facilitated by the CORE Chair, are available online at http://www.caqh.org/CORE_Transition_Committee.php.

About CORE
An initiative of CAQH, the Committee on Operating Rules for Information Exchange (CORE) is a multi-stakeholder industry collaboration developing operating rules that streamline administrative transactions. Over the past six years, CORE participation has grown to more than 120 participating organizations that represent approximately 75% of the commercially insured lives plus Medicare and Medicaid beneficiaries. CORE has a proven track record of rules adoption through certification and stakeholder return on investment. The CORE rules are improving provider access to patient benefits coverage and financial information at the point-of-care. Neither the CAQH Board nor CAQH staff has any veto or voting power related to the CORE rules. To learn more about CORE, visit www.caqh.org/benefits.php.

About CAQH
CAQH 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. Visit www.caqh.org for more information.

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