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.

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).

Meg Soccorso, Cigna

Molly ReeseAMA

Nora Illuri, athenahealth

Donna Campbell, HCSC

 

Monthly, adjourning September 2021

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, develop 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 Q2.

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.  

Type
Audience
Organization Type
CAQH Program