General CAQH CORE FAQs

III. CAQH CORE Measures of Success

1. What is the “CAQH CORE Measures of Success Study”?

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.
2. What are the CAQH CORE Measures of Success?

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.

3. Which entities participated in the Measures of Success Program?

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
  • RelayHealth
  • Montefiore Medical Center
  • NaviNet, Inc.
  • RealMed Corporation
  • WellPoint, Inc.