A new article in Group Practice Journal describes how providers can take greater advantage of the progress made by the CAQH CORE Operating Rules and Certification Program. Written by Susan L. Turney, M.D., CEO of Marshfield Clinic Health System and Vice-Chair of the CAQH CORE Board, the article emphasizes the importance of the work by CAQH CORE to streamline electronic business transactions and the need for greater industry participation in the certification program.
Turney describes how most providers should now have all of their payers—both public and private—conducting real-time processing of eligibility and benefits verification and claim status inquiries. Payers should also be offering the option to electronically receive payments, among other efficiencies in common business transactions due to CAQH CORE initiatives.
More than 300 CORE Certifications have been issued to date to health plans, providers, vendors and clearinghouses. The CORE Certification Program has enabled these entities to demonstrate that they and their business partners are adhering to the operating rules, which specify the actions for the seamless exchange of data.
While there has been great progress made to realize a world for health plans and providers where transactions are conducted efficiently, not all entities are participating in the effort, according to Turney. To ensure that more of the industry is following and benefiting from all four phases of the CAQH CORE Operating Rules there is more work to be done.
Turney offers suggestions for how providers can become more involved in the CORE Certification Program, including encouragement of increased vendor certification. When the vendors with whom they work become CORE Certified, providers can help move the industry toward a truly efficient system for exchanging administrative data in healthcare
The article is available now in the August issue of Group Practice Journal, the flagship publication of AMGA.