- CAQH ProView
- COB Smart
- Provider Directory - DirectAssure
- Primary Source Verification
- Operating Rules
- CORE Certification
- Industry Topics and Comment Letters
- Education and Implementation Resource Center
- HHS HIPAA Compliance
- Join CORE
CAQH TAPS EDIFECS TO CERTIFY ORGANIZATIONS, PRODUCTS FOLLOW CORE PHASE II RULES
Dept. of Veterans Affairs, Harvard Pilgrim Health Care, Aetna, Mayo Clinic Beta Testers
WASHINGTON, DC - 1/29/09–
Following successful beta testing with the U.S. Department of Veterans Affairs, Harvard Pilgrim Health Care and other leading healthcare organizations, CAQH announced today that it has named Edifecs as the authorized Committee on Operating Rules for Information Exchange (CORE) Phase II certification testing vendor.
CAQH launched CORE to create a national all-payer solution that enables provider access to patient insurance information before or at the time of service using the electronic system of their choice. The organization has brought together more than 100 industry stakeholders to collaborate on a multi-phase set of uniform business rules to achieve that goal.
The CORE Phase II rules expand upon the data consistency and interoperability improvements gained by rules created in CORE Phase I. The Phase II rules cover requirements for electronic connectivity, patient identifiers, claims status and reporting of year-to-date patient financial responsibility and coverage, including an increased number of service type codes that are defined by HIPAA.
In anticipation of the industry moving from HIPAA Version 4010 to Version 5010, CORE Phase I and Phase II rules incorporate many of the features found in the X12 5010 TR3s to address the common information needs for patient eligibility.
Using a set of objective, standards-based test scripts designed by CORE participants, Edifecs will test to certify that any interested health plan, health information technology vendor or large provider group can exchange data according to the CORE Phase II rules.
“We’re proud of the contributions we’ve made in advancing access to quick, consistent patient data through our role as an authorized Phase I testing vendor, as well as the administrative and clinical data integration CORE is helping achieve.” said Sunny Singh, company CEO. “Edifecs is very pleased to now have the further opportunity to help healthcare organizations streamline their electronic communications with this robust new set of rules.”
Edifecs has over 1,600 customers worldwide, with more than 350 customers and partners in healthcare, including 24 Blue Cross Blue Shield Plans, and over 35 Medicaid, State and Federal agencies. CAQH authorized Edifecs to certify healthcare organization compliance with the CORE Phase I rules in 2006.
Aetna, the Mayo Clinic, Athenahealth, CSC, RelayHealth and Visionshare also participated in the beta testing process. The multi-stakeholder aspect of the beta participants represents the breadth of organizations involved in end-to-end transmission of electronic data.
CAQH previously announced that more than 30 leading health plans, including Harvard Pilgrim Health Care, large provider groups and technology vendors are committed to completing Phase II rules certification testing by the end of 2009 or Q1 2010.
Harvard Pilgrim Health Care expanded their beta testing by developing an actual system and testing it live against the CORE Phase II connectivity rule. This extra step in the process has provided “real world” benefit to both CAQH and the health plan.
“By participating in the extensive beta testing process for CORE Phase II, we took an important step towards further expanding the major effort that is streamlining our administrative data processes,” said John Kelly, director of eBusiness Architecture for Harvard Pilgrim Health Care. “We look forward to becoming certified this year and hope our actions also help raise the bar for implementing efficient healthcare IT practices nationwide.”
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.
# # #