TEXAS MULTI-STAKEHOLDER COMMITTEE RECOMMENDS ADOPTION OF CORE RULES FOR ELIGIBILITY VERIFICATION

WASHINGTON, DC - 1/1/09

In its December 2008 Report and Recommendations Relating to the Facilitation of Electronic Health Insurance Data Exchange (pursuant to HB 522), the Texas Committee on Electronic Data Exchange has recommended insurers in the state of Texas use the CAQH Committee on Operating Rules for Information Exchange (CORE) Phase I rules. The CORE Phase I rules are to be used for electronically exchanging eligibility information.

The recommendation is particularly noteworthy because of the stakeholders involved in the committee. Members included representatives from national and regional health plans, health IT vendors, large provider groups and the state university system.

The report, sent to both the Texas Legislature and the Texas Department of Insurance (DOI), states, “The CORE Phase I standards build on current federal regulations but set higher standards, particularly with respect to the information to be returned by insurers in response to requests for eligibility information.” In 2009, the Texas Legislature or DOI is expected to address the committee recommendations.

Meeting over 10 times throughout 2007 and 2008, the committee discussed issues and solutions for giving “providers access to real time health insurance eligibility information in a manner which would genuinely benefit providers, insurers, and consumers.” Meetings were focused on reviewing the current landscape and future direction of the industry.

Many CORE-certified organizations and CORE participants operate in Texas. CORE Phase I-certified organizations serving Texas include health plans, Aetna, Inc. and WellPoint; a government group, the U.S. Department of Veterans Affairs; and numerous vendors, such as Availity, LLC and NaviMedix. CORE participant organizations with operations in Texas include CIGNA, Electronic Data Systems, Humana, IBM Corporation and TriZetto Group. A few organizations endorsing CORE, such as the American Medical Association, also have affiliates and/or regional partners in Texas.

Texas is one of the first states to sponsor a multi-stakeholder committee for the purpose of evaluating how national standards can assist with improving administrative transactions. Additionally, Texas is first in having a state-sponsored committee recommend adoption of the CORE rules. The committee also recommended the use of national standards developed by WEDI for healthcare ID Cards, a standard which CORE will be addressing in its Phase III rules.

As states determine how they can be catalysts for improving administrative data exchanges, several other states also are considering the CORE rules. CAQH is actively participating in these regional discussions by providing education about CORE. CAQH will keep you apprised of future developments.

Please see the full committee report for more information.

About CORE
CAQH, a nonprofit alliance of health plans and trade associations, launched the Committee on Operating Rules for Information Exchange (CORE) with the vision of giving providers access to eligibility and benefits information before or at the time of service using the electronic system of their choice. CORE has brought together more than 100 industry stakeholders to collaborate on a set of uniform business rules to achieve that goal. Built upon national standards such as HIPAA, each phase of CORE expands the pool of available data and advances system interoperability.

Please contact CAQH at (202) 861-6380 for additional information about CORE.

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