Healthcare Organizations Voluntarily Earn More Than 150 CAQH CORE Operating Rules Certifications

Milestone Reflects the Added Value Certification Brings to Operating Rules Implementation

WASHINGTON, DC - 10/15/14

The CAQH® Committee on Operating Rules for Information Exchange (CORE®) today announced that healthcare organizations have voluntarily earned more than 150 CORE Certifications and many additional organizations have pledged to become CORE-certified. These commitments are a promising development in the drive to achieve interoperability through end-to-end adoption of healthcare operating rules.

The CAQH CORE Operating Rules and voluntary Certification program are the result of an ongoing national collaboration among providers, health plans, vendors, associations, government entities, standard-setting organizations and others essential to improving claims-related transactions. Incorporating both data content and infrastructure, the operating rules enable high-quality, uniform data exchange across the healthcare system and support the integration of clinical and administrative data.

“The full potential of operating rules is realized when everyone involved in the transaction is using the rules,” explains George Conklin, chief information officer, CHRISTUS Health System and chair of the CAQH CORE multi-stakeholder board. “Like many organizations, CHRISTUS relies on vendor and trading partner systems to deliver the benefits of operating rules, enabling a coordinated data flow among health plans, vendors, and providers.”

CORE Certification promotes broader use of operating rules implementation and adds value by verifying that an organization operates in agreement with the rules and the underlying standards. It requires organizations to analyze and address how Operating Rules affect each of their trading partners.

“We want healthcare providers to know that whenever they exchange administrative data they can depend on real-time access to information needed to make timely and informed decisions,” says Howard Messing, CEO and President of MEDITECH, a software vendor and CHRISTUS Health trading partner that recently achieved CORE Certification. “Demonstrating compliance with the CAQH CORE Operating Rules through CORE Certification is essential to MEDITECH achieving that goal.”

CORE Certification was designed to be earned by all organizations – health plans, providers, vendors and clearinghouses – that can create, use or transmit administrative healthcare data. Working through Edifecs, the first CORE-authorized testing entity, certified organizations used a common set of test data to demonstrate that their systems can exchange information and return expected results with other systems as predicted by the operating rules and standards. CAQH CORE awards a Certification Seal that may be publicly displayed by those that successfully complete the certification process.

A complete list of all CAQH CORE Certifications is available at www.caqh.org/core/core-certified-organizations-pending-and-current. Recently awarded certifications include,

A range of national, regional, self-insured, public and private health plans, such as:

  • Blue Cross and Blue Shield of North Carolina
  • Centene Corporation
  • Florida Division of Medicaid
  • Tufts Health Plan
  • Oklahoma Office of Management and Enterprise Services Employees Group Insurance Division

Vendor and Clearinghouse products that connect thousands of large and small providers, hospitals and health plans:

  • athenahealth for athenaCollector
  • MEDITECH for EDI Eligibility Validation - Version Client/Server 5.66
  • PaySpan for PaySpanHealth.com
  • Trizetto Provider Solutions for Integrated Eligibility & Integrated Claim Status Inquiry

As part of the Patient Protection and Affordable Care Act (ACA), operating rules are included in the Federal vision for health data interoperability. The Phase I, II and III CAQH CORE Operating Rules became federally mandated for HIPAA-covered entities after the Department of Health and Human Services (HHS) designated CAQH CORE as the authoring entity of those operating rules. Congress also asked HHS to require health plans, including those that are self-insured, to certify their compliance with the operating rules and underlying standards. Earlier this year, HHS drafted a proposal recommending health plans meet this certification requirement either by achieving CORE Certification or attesting that some form of testing has occurred by December 31, 2015.

CAQH CORE offers a range of no-cost education programs to support implementation, end-to-end adoption, and certification of operating rules. Learn more at www.caqh.org.

About CAQH CORE

CAQH CORE is an industry-wide stakeholder collaboration committed to the development and adoption of national operating rules for administrative transactions. The more than 140 CORE Participants represent all key stakeholders, including providers, health plans, vendors, clearinghouses, government agencies, Medicaid agencies, banks and standard development organizations. To learn more about CAQH CORE, visit www.caqh.org. Follow us on Twitter: @caqh.

# # #