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Current Initiatives of 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
CORE Code Combinations Task Group Rule Maintenance
  • Ensure compliance with the base standard code lists – CARCs and RARCs.
  • Conduct industry survey every two years to collect input on market-driven updates 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
Pilot & Measurements ROI; Opportunity Identification
  • Electronic Prior Authorization Measurement Initiative: Collaborate with CORE to track and assess the implementation of the CMS 0057 Final Rule.
 N/A Ongoing
Claim Status Data Content Subgroup (CSSG) Rule Development
  • Identify data content requirements for claim status inquiry transactions, claim status responses, and claim status reporting to prevent unnecessary denials and costly resubmissions or appeals. The subgroup will also explore how APIs could support real-time claim status checks.
 Tyler Scheid, AMA
Kristin Thonsgaard, Optum		 Every six weeks starting in early March 2025.

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