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Patient Insurance Verification Through CAQH CORE Effort
CAQH announced today that four more organizations have joined in its national initiative to streamline patient insurance coverage verification before or at the point of care.
CSC (NYSE: CSC) and Post-N-Track now have products certified as operating in compliance with CAQH Committee on Operating Rules for Information Exchange (CORE) Phase I rules. As a result, providers and hospitals using CSC’s DirectConnect and/or Post-N-Track’s DoohickeyTM Web Services product can access consistent eligibility and benefits information in seconds.
Additionally, CAQH announced that Omega Technology Solutions will contribute to CORE rules development as a participating organization; and the American Association of Preferred Provider Organizations has endorsed the CORE mission and Phase I rules.
CAQH, a nonprofit alliance of health plans and trade associations working to streamline healthcare administration, launched CORE to create an all-payer solution that gives providers access to insurance information before or at the time of service using the electronic system of their choice for any patient or health plan. The CORE rules, developed by more than 100 healthcare industry stakeholders, are built on existing national standards, such as HIPAA.
“Efficient administrative data exchange should be an essential component of any eHealth strategy,” said Deward Watts, president, CSC’s Global Healthcare Sector. “The CORE rules are a very effective approach for achieving that goal.”
More than 30 healthcare organizations, including health plans covering approximately 65 million or one-third of U.S. commercially insured lives, are now CAQH CORE-certified. Over 20 other healthcare associations, accrediting bodies, networks and businesses have endorsed the CORE rules.
Attesting to the growing importance of CORE certification, Aetna now requires all of its administrative data exchange vendors to be certified in compliance with the CORE rules.
The Blue Cross and Blue Shield Association recently expressed its support for the initiative with the following statement: "BCBSA is pleased to participate in CAQH CORE's efforts to streamline electronic eligibility. Simplifying provider access to patient insurance coverage information is critical and the Blues believe that CORE is a key initiative to bring the industry together for collaboration and consensus building."
A multi-phased initiative, CAQH expects to launch the CORE Phase II rules in July 2008. CORE’s second set of rules builds on those from Phase I, with additional rules for patient identifiers, patient accumulators, claims status and connectivity. Phase II also requires reporting of patient financial responsibility for an increased number of service codes.
CAQH has already begun work on the CORE Phase III rules, which will focus on improving the electronic exchange of additional administrative transactions, such as prior authorization.