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.
|
Initiative |
Focus |
Current Objectives |
Co-Chairs |
Cadence |
| Eligibility & Benefits Task Group | Rule Development | Update the Eligibility & Benefits Data Content Rule to address emerging industry needs (such as support more STC codes, tiered benefits, procedure-level, # of remaining visits/services, telemedicine). | TBD | TBD |
|
Pilot & Measurement Initiative |
Prior Authorization & Attachments; Quality Measures Reporting |
Work with other CORE Participating Organizations and CAQH to measure the impact of potential operating rules and corresponding standards on entities’ efficiency metrics. |
N/A |
N/A |
| Attachments Subgroup (Prior Authorization Use Case) | Rule Development | Develop operating rules to improve automation of the exchange of attachments/additional medical document; initial focus on prior authorization use case. |
Santo Carino, Epic Bob Gross Cleveland Clinic Mahesh Siddanthi, Centene |
Monthly, adjourning March 2021 |
| Attachments Subgroup (Claims Use Case) | Rule Development | Following the prior authorization use case, evelop operating rules to improve automation of the exchange of attachments/additional medical document; with a focus on claims attachments. |
TBD |
Launching Q2, meeting monthly through Q3. |
|
CORE Code Combinations Task Group |
Rule Maintenance |
Ensure compliance with the base standard code lists – CARCs and RARCs. Conduct annual industry survey to collect suggestions for potential market-driven adjustments to code combinations. |
Shannon Baber, UW Medicine Nathan Fisk, Change Healthcare Lynn Franco, UnitedHealth Group Heather Morgan, Aetna |
Once every 2-3 months, for a total of 6 times a year |
If you would like to join any of the following initiatives, please contact core@caqh.org.
