CORE: Advancing Electronic Data Exchange and Connectivity

The benefits of an interoperable healthcare system are well understood. The availability of information in real-time at the point of care can reduce medical errors, allow physicians and their patients to make informed decisions about treatment options, and reduce administrative burdens. The challenges are equally well understood. Technology adoption rates, data security, and inconsistency associated with transactions and interactions between stakeholders limit the ability to realize a complete solution.

Through CORE, CAQH is working to make it easier for physicians and hospitals to access patient insurance information before or at the point of care. CORE operating rules are streamlining eligibility, benefits, and claims data by allowing providers to submit a request, using the electronic system of their choice, to obtain a variety of coverage information for any patient and from any participating health plan. Providers will receive more consistent and predictable data, regardless of health plan.