Current Initiatives for CAQH CORE Participants

CAQH CORE Participating Organizations help ensure that operating rules continue to meet evolving business needs, by engaging in the rule development process and maintenance of existing operating rules. Work groups are open to all CAQH CORE Participating Organizations, and multiple individuals from the same Participating Organization may join. Because each organization has only one vote, participants collaborate with their colleagues to submit an organizational-level response during voting periods. 

Below is a list of CAQH CORE work groups that currently convene or are upcoming as well as initiatives that are underway. In addition to contributing to these work groups and initiatives, as well as the formal CAQH CORE voting process, Participating Organizations benefit from exclusive education content and research opportunities. If you would like to join any of the following initiatives, please contact core@caqh.org.  

Initiative

Focus

Current Objectives

Status

CORE Code Combinations Task Group

 Rule Maintenance

Ensure compliance with the base standard code list (CARCs and RARCs). Conduct annual industry survey to collect suggestions for potential market-driven adjustments to code combinations.

Active
CAQH CORE Prior Authorization Pilot Project ROI; Opportunity Identification Apply existing and potential new data content and infrastructure operating rules to close automation gaps in the prior authorization workflow (relating to discovery of services requiring PA, exchange of PA requests and responses, information needs, etc.) Measure the impact of operating rules and corresponding standards on entities' efficiency metrics.   Active
CAQH CORE Attachments Advisory Group Rule Opportunity Identification Consider operational areas for action to improve automation in the exchange of attachments/additional clinical information; as identified in the CAQH CORE Attachments White Paper published in May 2019. Active
CAQH CORE Value-based Payments (VBP) Rule Development Group Rule Development Evaluate operating rule development or pilot program development for opportunity areas prioritized by the VBP Advisory Group, with a focus on Provider Attribution. Active
CAQH CORE Enrollment Data Task Group Rule Maintenance

Conduct a Comprehensive Review of the Enrollment Data Sets and consider adjustments as needed (substantive and non-substantive adjustments).

 Active
Type: 
Article
Audience: 
Public
Organization Type: 
Health plans
CAQH Program: 
CORE