CAQH CORE White Paper: The Connectivity Conundrum

January 2020

Over the years, healthcare industry stakeholders have implemented a multitude of methods connecting applications, systems and networks to exchange administrative and clinical healthcare data. This has resulted in a fragmented ecosystem that is impeding interoperability and administrative simplification.

Connectivity Conundrum: How a Fragmented System is Impeding Interoperability and How Operating Rules Can Improve It,” a recent white paper from CAQH CORE, is an in-depth study of the challenges and opportunities associated with connectivity and includes:

  • A definition of connectivity and its importance to the healthcare system;
  • A history of government and industry efforts to improve connectivity, beginning with the implementation of HIPAA electronic transaction standards in the early 2000s through today;
  • An explanation of how the industry came together to create the CAQH CORE Connectivity Rules to improve interoperability across healthcare and the progress that has been made to date;
  • Illustration of how the diversity of connectivity methods used to today are adding complexity and discouraging interoperability;
  • A use case demonstrating how connectivity between clinical and administrative systems is essential for an efficient prior authorization process;
  • Technical breakdown of emerging technologies, including REST, SOAP and APIs.

Since the Phase I and II CAQH CORE Connectivity Operating Rules were mandated by the Department of Health and Human Services (HHS) in 2013, connectivity across healthcare has significantly improved, but much work remains. To keep pace with the rapidly accelerating volume of data flowing across the healthcare system, the industry needs to coalesce around connectivity protocols, and the white paper provides a roadmap for how to accomplish this.

In 2020, CAQH CORE participating organizations will consider enhancements to the CAQH CORE Connectivity requirements to move the industry towards a common set of Safe Harbor connectivity methods. These methods address existing and emerging standards and protocols to support the intersection of administrative and clinical data exchange. 

To download the white paper, click here.

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