Delivering Administrative Efficiency and Value to the Healthcare Industry
CAQH CORE engages the healthcare industry in developing consistent business processes for patients, providers and health plans to streamline the business of healthcare. More than 110 organizations participate in CAQH CORE, including healthcare providers, health plans, vendors, government entities, associations and standard-setting organizations. Health plans participating in CAQH CORE represent 75 percent of the insured population in the United States.
Collectively, CAQH CORE and Participating Organization's efforts are focused on:
- Influencing the direction of health IT policy.
- Leading development of operating rules that remove unnecessary cost and complexity from the healthcare industry.
- Identifying new opportunities to accelerate the industry’s transition to a fully digital business.
CAQH CORE is the national operating rule author to improve the efficiency, accuracy and effectiveness of industry-driven business transactions.
The Department of Health and Human Services (HHS) designated CAQH CORE as the author of national operating rules for the HIPAA-covered administrative transactions.
Drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers and consumers.
CAQH CORE released guidance for how healthcare providers and plans can meet the Advanced Explanation of Benefits (EOB) requirements included in the No Surprises Act, signed into law in December 2020. To develop the guidelines, CAQH CORE convened an advisory group that included more than 60 participants from 30 diverse healthcare organizations, including providers, health plans, vendors, clearinghouses, associations, government entities and standards development organizations.
Participation in the CORE Certification program is for organizations that create, use or transmit administrative healthcare data (such as health plans, healthcare providers and vendors). CORE Certification verifies that an organization or product operates in agreement with the operating rules and the underlying standards, and is doing so with their trading partners.