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

Value-based Payments (VBP) Subgroup

Rule Development

Develop operating rules to support the exchange of patient/provider attribution information to enable greater uniformity.

Troy Smith, Vice President Healthcare Strategy and Payment Transformation, BCBSNC

Once monthly, from Oct 2019 to August 2020 (11 Calls)

Value-based Payments (VBP) Review Work Group Rule Review Evaluate the two draft rules developed by the VBP Subgroup: one pertaining to the attribution status of a single patient and one for a roster of patients.
 

 
Troy Smith, Vice President Healthcare Strategy and Payment Transformation, BCBSNC August 2020
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.

Patrick Murta, Solutions Architect Fellow, Humana      Michael Privat, VP Digital-Cloud Migration, Availity    Megan Soccorso, Business Product Senior Specialist, Cigna

Once monthly, from February 2020 to July 2020 (5 calls)

Prior Authorization Pilot & Measurement Initiative

ROI; Opportunity Identification

Apply existing and potential new data content and infrastructure operating rules to close automation gaps in the prior authorization workflow.

Measure the impact of operating rules and corresponding standards on entities’ efficiency metrics

N/A

N/A

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 TBD

Launching July 2020

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.  

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