WASHINGTON, DC - 3/13/06

CAQH announced today that it has received a grant from the California HealthCare Foundation (CHCF), an independent philanthropy committed to improving California's health care delivery and financing system, to target patient identification as a component of its Committee on Operating Rules for Information Exchange (CORE) initiative.

The grant is one of eight providing funds to develop pilot projects in California that show promise for reducing health spending. The CHCF program is designed to foster innovative approaches for achieving cost savings throughout the healthcare system, rather than shifting costs from one sector to another.

CAQH launched CORE in January 2005 to improve provider access to patient eligibility and benefits information. The initiative is developing a set of operating rules, modeled on those used in the banking industry to facilitate ATM and direct-deposit banking, to achieve that result. Operating rules build on existing standards, such as HIPAA, to make electronic transactions more predictable and consistent, regardless of the technology, thus facilitating interoperability. CORE operating rules:

  • Enhance interoperability between providers and payers
  • Streamline eligibility and benefits data transactions
  • Reduce the amount of time and resources providers spend on administrative functions – time better spent with patients.

CAQH will use the grant to define the business case for patient identification for administrative transactions, draft operating rules to support that business case and design a California-based pilot to test the draft rules and estimate potential administrative savings. Through CORE, operating rules will be developed to help providers submit a request for patient eligibility and benefits data and achieve accurate and secure patient matching by the health plan, potentially even when the patient’s health insurance number is not known at the point of care.

“This grant is a positive statement about CORE’s collaborative approach to simplifying administrative data exchange,” said Robin J. Thomashauer, CAQH executive director. “We are very pleased that the foundation is helping us address patient identifiers in the second phase of our initiative.”

More than 80 healthcare industry stakeholders – health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and banking industry experts – collaborate to develop CORE operating rules.

“Quick, accurate patient identification is needed and desired throughout the healthcare industry,” said Marian Mulkey, M.P.H., M.P.P., senior program officer, Health Insurance, at CHCF. “CAQH’s initiative has potential cost-saving implications for a broad range of clinical and administrative processes; the foundation is delighted to support this endeavor.”

CAQH ( is a nonprofit alliance of the nation’s leading health plans and networks working to simplify healthcare administration. CAQH solutions help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration, facilitate administrative healthcare information exchange and encourage administrative and clinical data integration.

Chris McNamara
(202) 778-3271

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