CAQH CORE has awarded more than 350 certifications to healthcare organizations that conform to CAQH CORE Operating Rules. In becoming certified, these entities – which include health plans, Medicaid programs, providers, vendors and more – demonstrate their commitment to automation, interoperability and efficient business processes.
“This is an important milestone for the state of healthcare nationwide,” said Dr. Susan Turney, CEO of Marshfield Clinic Health System and CAQH CORE Board Chair. “Becoming CORE-certified ensures that organizations are aligned with industry-driven operating rules and perform administrative transactions efficiently.”
The CAQH CORE Certification program is the most robust, independent testing program available. The program consists of four phases of operating rules, most of which are federally mandated. Becoming CORE-certified offers many benefits, including assurance of optimal data exchange capabilities. Ultimately, CORE Certification saves organizations time and money. Security Health Plan of Wisconsin and eligibill, Inc. are the latest to join the growing list of CORE-certified entities.
We are always looking for opportunities to improve administrative efficiencies. CORE Certification demonstrates our commitment to this goal. It also helps us improve our information exchange capabilities. – Angela Kissinger, Chief Compliance Officer at Security Health Plan of Wisconsin
HIPAA created the Transaction Standards, but not the means of communication between trading partners. CAQH CORE closes the loop and allows for secure internet communications of transactional data. – Robert Thickens, President and CEO at eligibill, Inc.
To date, CORE-certified health plans cover 78 percent of commercial lives, 75 percent of Medicare Advantage lives and 44 percent of Medicaid lives in the United States. While adoption of operating rules for electronic transactions is on the rise, there continues to be a large savings opportunity across the industry, related to overall adoption of electronic transactions. In fact, the 2018 CAQH Index found that more than $12 billion in savings can still be realized across the industry.
“Increased participation in the CAQH CORE Certification program is an indication of industry commitment to making business transactions more efficient,” said April Todd, Senior Vice President, CORE and Explorations at CAQH. “CAQH is committed to ensuring entities have the resources they need to become CORE-certified and make progress toward electronic adoption.”
CAQH CORE continues to improve the CORE Certification process and develop new operating rules as the healthcare industry evolves. Over the next few months, CAQH CORE expects to rollout Phase V CORE Certification for prior authorization. To find out more about the CAQH CORE Certification program, visit https://www.caqh.org/core/core-certification.