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.

Initiatve 

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 Initiative 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 Value-based Payments (VBP) Rule Development Group Rule Development Develop operating rules to create uniform expectations for the exchange of provider attribution information. Operating rules will  focus on data content, infrastructure and exchange method and format  requirements. Active
CAQH CORE Connectivity & Security Work Group  Rule Update Consider a Safe Harbor for additional connectivity methods (e.g.  REST, APIs) in order to further support the alignment of  administrative and clinical data exchange, as well as to align with  efforts to support consumer data access. Active
CAQH CORE Attachments Subgroup Rule Development  Develop operating rules to improve automation of the exchange of attachments/additional medical documentation; initial focus on prior  authorization use case.​ Upcoming

 If you would like to join any of the following initiatives, please contact core@caqh.org.  

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