New Information Standards to Help Eliminate Doctor’s Office Clipboard

CAQH CORE Rules Allow Providers to Rapidly Verify Insurance Coverage, Eligibility

WASHINGTON, DC - 12/7/06

CAQH announced today that U.S. healthcare providers are now one step closer to eliminating their office insurance clipboards. According to the nonprofit healthcare alliance, administrative data communication rules created by its Committee on Operating Rules for Information Exchange (CORE) have been included in the Health Information Technology Standards Panel (HITSP) Consumer Empowerment specifications recommendation to the U. S. Department of Health and Human Services.

HITSP provides a process for stakeholders to identify, select and harmonize standards for communicating healthcare information throughout the healthcare spectrum. As defined by the panel, consumer empowerment is the active involvement of consumers (i.e., individuals) in managing their healthcare and gaining the benefits of having their health information in a format easily accessible to them. This includes having a personal health record (PHR) to track patient information, insurance, family history, medications, and other special conditions.

PHRs will allow consumers to establish and manage access to their medical and insurance information by designated caregivers and healthcare providers without having to repeat the information at every step in the care process. Currently, HITSP’s Consumer Empowerment specifications address two key areas of the PHR: patient registration data and medication history. The CORE rules will help deliver consistent and robust patient insurance information to the patient’s PHR for provider use in patient registration, CAQH said.

“CORE is a revolutionary, industry-wide solution that significantly improves administrative data exchange and promotes interoperability,” said Bob Greczyn, CAQH Board chairman and CEO and President of Blue Cross and Blue Shield of North Carolina. “ HITSP inclusion of CORE is further proof that CAQH’s collaborative process is creating rules that will have lasting value for the industry.””

Market demonstration of the HITSP Consumer Empowerment specifications is currently underway. The CORE Phase I rules will be used as part of the interoperability testing of the HITSP Consumer Empowerment specifications at the Integrated Healthcare Enterprise 2007 North American Connectathon in January. Later next year, the CORE rules, and their role in helping the HITSP consumer empowerment goals, are scheduled to be demonstrated at the HIMSS National Conference Interoperability Showcase February 25 – March 1, 2007.

CAQH launched CORE to promote health plan-provider interoperability and improve provider access to administrative information. To date, the voluntary industry-wide initiative has brought together nearly 100 industry stakeholders, including health plans, providers, vendors, the Centers for Medicare and Medicaid Services and other government agencies, associations, regional entities, standard-setting organizations and others, that cover more than 130 million lives, or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries. In collaboration, they have built consensus on a set of operating rules to:

  • 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

CORE Operating rules build on existing standards, such as HIPAA, to make electronic transactions more predictable and consistent, regardless of the technology.

CAQH previously announced that 20 leading national healthcare organizations will become CORE certified and begin exchanging select eligibility and benefits information with providers according to the CORE rules by March 31, 2007. Those organizations include Aetna, Inc.; AultCare; Blue Cross Blue Shield of North Carolina; Emdeon; Health Plan of Michigan; Health Net, Inc.; Humana Inc.; Mayo Clinic; McKesson Provider Technologies; Montefiore Medical Center; Siemens; and WellPoint, Inc. and its 14 Blue-licensed subsidiaries.

More than 20 additional organizations, including Accenture; the American Academy of Family Physicians; the American College of Physicians; the American Health Information Management Association; the Healthcare Financial Management Association; the Healthcare Information and Management Systems Society; the Medical Group Management Association; Microsoft Corporation; and the Workgroup for Electronic Data Interchange, have endorsed the CORE Phase I rules.

About CAQH
CAQH is a catalyst for healthcare industry collaboration on initiatives that simplify and streamline 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. Visit for more information.

Chris McNamara
(202) 778-3271

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