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III. CAQH CORE Measures of Success
The CAQH CORE Measures of Success Study is the method CAQH CORE used to track the financial/operational impact, by stakeholder type, of implementing the Phase I CAQH CORE Operating Rules. Specifically, volunteers from each stakeholder type tracked, quarterly, a small set of standard metrics agreed upon by the volunteering entities. The purpose of the Measures of Success Study was to:
- Support CAQH CORE’s momentum by reminding participants of both past and current progress they have achieved
- Demonstrate market need for the CAQH CORE Operating Rules by tracking actual direct/indirect ROI benefits of the operating rule
- Provide easy story for the press/media existence and tracking of concrete health care measures of success that were developed by a group of multi-stakeholder CAQH CORE Participants
- Participating in the Measures of Success Program is not a requirement for completing CORE Certification.
The CAQH CORE Measures of Success are a realistic set of metrics (e.g., change in call volumes/EDI inquiries), by stakeholder group (health plans, front-end vendors, clearinghouses, and providers), used to measure the benefits of Phase I CAQH CORE Operating Rules adoption. The metrics include agreed-upon methodologies that were applied by each stakeholder group to track the impact of the Phase I CAQH CORE Operating Rules. Results from the Phase I CAQH CORE Measures of Success Program are published and available at http://www.caqh.org/COREIBMstudy.php.
The following entities participated in the Phase I CAQH CORE Measures of Success Program:
- Aetna, Inc.
- Blue Cross and Blue Shield of North Carolina
- Cedars-Sinai Health System
- East Carolina University School of Medicine Physicians
- Change Healthcare
- Health Net, Inc.
- IBM Corporation
- Montefiore Medical Center
- NaviNet, Inc.
- RealMed Corporation
- WellPoint, Inc.