New Certification Progress Report Highlights Healthcare Industry Progress and Gaps in Move Towards Streamlined, Electronic Sharing of Administrative Data
CAQH CORE, a multi-stakeholder collaboration of more than 130 public and private entities across the healthcare industry, announced today that it has awarded over 300 certifications to health plans, hospitals and health systems, clearinghouses and vendors. Aetna and Cigna, two of the nation’s largest insurers, recently became certified in the Phase III CAQH CORE Operating Rules, continuing the industry momentum toward more streamlined, electronic administrative data sharing.
Operating rules are used across a multitude of industries to ensure a high volume of electronic transactions – from banking to airline reservations – can occur smoothly and securely. CAQH CORE brought together industry stakeholders to develop similar operating rules for healthcare. The organization also created a voluntary method for testing that enables health plans, providers, clearinghouses and vendors to demonstrate their adherence to the rules and underlying standards for exchanging electronic administrative data.
Today, CAQH CORE awards certifications for three phases of operating rules, each covering a different set of healthcare transactions. Phase IV certification will be available this spring.
“For Aetna, becoming CORE Certified has been a priority,” said Lou Ursini, Chair of the CAQH CORE Board and head of IT program delivery and testing for Aetna. “Completing certification Phases I, II and III helps us both push the industry forward and ensure that all of our business partners – especially healthcare providers – receive the benefits of the rules.”
A new CORE Certification Progress Report found that health plans certified in Phases I and II cover 76 percent of commercially-insured Americans and 44 percent of those publicly insured – demonstrating significant progress in just a few years. While certifications for the Phase III rules, which streamline the electronic funds transfer and electronic remittance advice process, are growing, the report also shows that health plans certified for this phase only cover 27 percent of the commercially insured and 25 percent of those publicly insured, highlighting the need for greater adoption of the operating rules in this important area.
To achieve real interoperability across the healthcare economy, both health plans and providers must follow the operating rules and underlying standards. Today, we have the information we need to understand health plan adoption. To gain an understanding of provider adoption, CAQH CORE is working with practice management companies and other CORE Certified vendors that enable provider organizations to exchange data efficiently with health plans. The findings will be reported in future progress reports.
“In a changing healthcare policy environment, CORE Certification is more important than ever,” said Gwendolyn Lohse, CAQH CORE Managing Director. “For the business of healthcare to evolve as a working whole – and do so more efficiently than it does today – all parties need to follow the same fundamental rules, and CORE Certification enables everyone to have confidence that this is happening.”