CORE NEWS
CAQH launched the Committee on Operating Rules for Information Exchange (CORE) to develop an all-payer solution that ensures electronic healthcare administrative data exchange is streamlined and consistent, regardless of the technology. CORE is more than 100 industry stakeholders collaborating on a set of uniform business rules that are built on existing industry requirements. CORE participating organizations collectively cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.
CORE Phase II Rules Nearing Completion
Building on Phase I rules, Phase II rules will soon be complete. The CORE rules are being developed in phases, with increasingly more complex content and infrastructure requirements. This approach allows organizations to build on previous phases and progressively adopt new standards.
Before a phase launches, CORE rules go through a voting process. View the CORE Phase II voting timeline. The CORE Phase II rules are currently in CORE Work Group balloting -- the first level of CORE voting.
The proposed CORE Phase II includes five new rules and the Phase II test suite:
The proposed Phase II rules will be presented during a WEDI/CAQH audio conference on May 28, 2008. WellPoint, Availity, and Montefiore Medical Center will share their perspectives on participating in the CORE Phase II rules development process and describe the potential impact the rules will have on the healthcare industry. Register for the audiocast today.
CAQH expects to announce the first CORE Phase II certifications during the fall of this year.
CORE Phase III Rules
CORE Phase III Work Groups will begin meeting to discuss the potential Phase III scope after the Phase II balloting is complete. Areas of interest will be identified to determine the focus of Phase III. The rules will be developed in accordance with CORE's long-term vision and harmonize CORE with other industry efforts.
CORE staff has begun behind-the-scenes planning, including discussions with industry groups, reviewing current and upcoming national efforts in the HIT arena, and identifying needed subject matter experts.
CORE In The News
Aetna Requires CORE Rules
Aetna is the first national healthcare organization to require all of its administrative data-exchange vendors to be certified in compliance with the CORE rules.
Read the full press release here.
RxHub Becomes CORE Certified
RxHub, a leader in e-prescribing, has completed the testing process required to certify its PRN clearinghouse product operates in compliance with the CAQH CORE Phase I operating rules. This achievement represents an important step toward synchronizing interoperability efforts in the medical and pharmacy sectors.
Read the full press release here.
HITSP Adopts CORE Data Content Rule
CAQH announced earlier this year that the eligibility data content section of its CORE Phase I rules is a final component of the Healthcare Information Technology Standards Panel’s (HITSP) first set of interoperability standards; specifically, the HITSP Consumer Empowerment Interoperability Specifications. These standards were formally recognized by Health and Human Services Secretary Mike Leavitt in late January.
Read the full press release here.
State Updates
Individual states are considering different ways to simplify healthcare administration. The benefits of CORE are being recognized in several of these states:
Colorado - A report commissioned by the state identified the efficiency of electronic transactions in healthcare as a means of cost savings. CAQH was invited to meet with stakeholders, including members of the Colorado Association of Health Plans and officials from the State Insurance Department, to explain CORE's mission. At the meeting, CAQH outlined how CORE addresses the importance of multi-stakeholder commitment to administrative cost reduction. In addition, CAQH discussed how CORE can serve as a key component of state e-health strategies.
Ohio – State legislation mandated the establishment of an Advisory Committee to study the formulation of state-specific eligibility requirements. CORE has been included in early drafts of legislation and CAQH continues to be available to the Committee as an educational resource.
Texas - Texas passed legislation that is partly focused on eligibility; CORE is mentioned in this legislation. CAQH has met with various Texas stakeholders to discuss CORE and how it relates to a Patient ID Card Pilot Program that the state is also considering. Meetings have included the Committee on Electronic Data Exchange, state health plans, state legislators, and the Texas Department of Insurance.
Virginia - The Virginia Healthcare Exchange Network (VHEN) is encouraging participants to adopt and apply the CAQH CORE Phase I operating rules to exchanges of eligibility transactions among Virginia payers and providers.
