CAQH AND EHNAC PARTNERSHIP TO DISCOUNT FEES FOR CLEARINGHOUSES
SEEKING BOTH CORE RULES CERTIFICATION AND HNAP ACCREDITATION
CAQH® and the Electronic Healthcare Network Accreditation Commission (EHNAC) announced today that they have formed a partnership to promote electronic health data exchange through, and industry best practices for, clearinghouses.
The partnership is centered on the CAQH Committee on Operating Rules for Information Exchange® (CORE) initiative and EHNAC Healthcare Network Accreditation Program (HNAP). CAQH and EHNAC entered into the partnership after completing a detailed comparison of the CORE rules, which set requirements for data exchange, and HNAP accreditation criteria for clearinghouse operations. The analysis determined both efforts have complementary, yet distinct, requirements.
The first joint action of the partnership is a program that offers fee discounts to clearinghouses (otherwise known as electronic health networks – EHNs) that want to achieve both CORE rules certification and HNAP accreditation. Clearinghouses with HNAP accreditation will receive a discounted fee when applying for CORE rules certification. In turn, any clearinghouse that is CORE-certified will receive a discounted fee when applying for HNAP accreditation.
“Both of our organizations are committed to improving healthcare data exchange,” said Robin Thomashauer, CAQH executive director. “By working together, we can more quickly advance adoption of industry best practices.”
CAQH launched CORE to create an industry-driven solution that can support all payers and enables consistent provider access to patient insurance information before or at the time of service using any electronic system. The organization has brought together more than 100 industry stakeholders to collaborate on its multi-phase set of uniform business rules to achieve that goal. CORE participants provide coverage for over 130 million lives, or more than 75 percent of the commercially insured plus Medicare and Medicaid beneficiaries.
To date, over 40 leading clearinghouses, health IT vendors, health plans and large provider groups are certified as exchanging electronic administrative data in accordance with the CORE rules. CORE-certified health plans cover approximately 65 million or one-third of U.S. commercially insured lives.
“Our partnership is a logical extension of the work both of us do to broaden the use of electronic healthcare transactions and eliminate administrative redundancy,” said Lee Barrett, EHNAC executive director. “We are delighted to collaborate with CAQH on streamlining healthcare administration.”
EHNAC has implemented several industry accreditation programs designed to assist clearinghouses benchmark their performance against industry-accepted guidelines and standards. HNAP, the primary EHNAC accreditation program, examines confidentiality enforcement, review of level-of-service and escalation procedures, and outcome-related metrics.
The organization also reviews security infrastructures, including disaster recovery, business continuity and contingency planning, as well as ability to comply with industry-standard data formats.
Moving forward, CAQH and EHNAC will review their participant requirements and evaluation methods to ensure there is no duplication of effort. This will enable both organizations to collaborate on other actions aimed at meeting the end-goal of simplified, transparent, secure and robust administrative transactions.
