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

Advanced EOB Advisory Group Guidance Development

Guide CAQH CORE's work on price transparency with an immediate focus on the advanced EOB requirements in the No Surprises Act. The Advisory Group developed a guidance document for industry to support the provider/payer exchange for advanced EOB that was published in November 2021. The guidance may be considered for a future CAQH CORE Operating Rule.

N/A

Reconvening December 2021

Review Work Group (RWG) Rule Development Further reviewing and refining draft rules including both Draft Attachments Operating Rule Sets to ensure uniformity and cohesion across use cases, the Draft Eligibility and Benefits Data Content Rule Update, and Infrastructure Rule Updates. 

Donna Campbell HCSC

Mehesh Siddanati Centene

Molly Reese AMA

Launching Q3, Meeting Monthly, potentially through early 2022

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

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