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CAQH CORE Approves Operating Rules on Value-based Payments and Interoperability

Last month, CAQH CORE passed new Operating Rules for patient attribution data exchange and an update to existing connectivity rules:

CAQH CORE Value-based Payments Attribution Rules Package

Attribution refers to how a patient is assigned to a provider who is then responsible for the quality and cost of his or her care. This process is an essential part of value-based healthcare, in which providers are compensated based on health outcomes of those patients attributed to them. However, providers often find out too late and through inconsistent sources that a patient is attributed to them. The new rules package establishes uniform expectations for the electronic exchange of attribution data between health plans and providers, and the frequency by which it is shared.

CAQH CORE Connectivity Rule vC4.0.0

First introduced in 2008, the CAQH CORE Connectivity Rule establishes a national standard for how healthcare entities exchange data. It is a fundamental part of healthcare interoperability. The latest version has been updated to support protocols organizations are now using to connect, such as REpresentational State Transfer (REST) and other application programming interfaces (APIs). This update aligns with CMS and ONC Interoperability Rules, and moves the industry closer to a single, uniform approach.

CAQH CORE Operating Rules support a range of standards to make electronic data transactions more predictable and consistent. The organization has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for federally mandated operating rules under the Health Insurance Portability and Accountability Act (HIPAA).

In 2020, CAQH CORE restructured its operating rules from phase-based rule sets to rule sets based on business transactions, creating a flexible framework for adding new rules/requirements, updating existing operating rules and removing outdated requirements for each business transaction.

The new Operating Rules will be ready for industry implementation in 2021. 

To learn more about CAQH CORE Operating Rules, click here.