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 |
| Launching Soon: Health Care Claims Subgroup | Rule Development |
After confirming direction with a Health Care Claims Focus Group in Q4 of 2022, CAQH CORE will convene the Health Care Claims Subgroup on Thursday, April 13th 2023 with a focus on establishing data content requirements for transactions supporting claim submission, acknowledgment and error reporting that mutually help avoid rejections and costly downstream appeals. The subgroup may further consider the application of these requirements to use cases including Telehealth Billing and Coordination of Benefits. |
Megan Soccorso Gainwell Technologies Randy Gabel OhioHealth Olga Khabinskay HBMA Mahesh Siddanati Centene |
Monthly, meeting 4 to 5 times |
| Launching Soon: Value-based Payments Subgroup | Rule Development | Industry representatives participated in a VBP Focus Group in Q4 of 2022 to inform the agenda for a CAQH CORE Value-based Payment Subgroup launching in Q2 of 2023. The subgroup will provisionally focus on the advancement of social determinants of health in value-based payment programs through the creation of data content rules for the claims submission transaction and benefit enrollment transaction. Given the indicated focus areas, the Subgroup's work may intersect or be informed by that of the Health Care Claims Subgroup and collaborative opportunities will be actively explored. |
TBD |
Monthly, meeting 4 to 5 times |
|
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. |
Lynn Franco UnitedHealth Group Heather Morgan Aetna Tyler Scheid AMA |
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.