Frequently Asked Questions - II. Development of Voluntary Operating Rules

Will CAQH CORE continue to develop operating rules for voluntary industry adoption in addition to the operating rules being developed to fulfill the requirements under HIPAA?

Submitted by caqh_admin on Tue, 12/22/2015 - 06:02
Will CAQH CORE continue to develop operating rules for voluntary industry adoption in addition to the operating rules being developed to fulfill the requirements under HIPAA?

Yes. CAQH CORE was established in 2005 to build consensus among healthcare industry stakeholders on a set of voluntary operating rules that facilitate administrative interoperability between providers and health plans. Interoperability ensures that information can be uniformly requested, provided, and understood by all stakeholders. Additionally, interoperability reduces the amount of time and resources providers must exert on administrative functions – time better spent with patients.

Given the ROI to be achieved, CAQH CORE is committed to continuing to use the CAQH CORE Guiding Principles to develop healthcare operating rules for voluntary adoption by the industry. This voluntary work includes drafting new voluntary operating rules to address industry pain points and evolving business needs.

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How can my organization be involved in development of the CAQH CORE Operating Rules?

Submitted by caqh_admin on Tue, 12/22/2015 - 06:10
How can my organization be involved in development of the CAQH CORE Operating Rules?

CAQH CORE uses an open, transparent process to draft its operating rules and any organization is welcome to join this process. CAQH CORE Participants engage in CAQH CORE operating rule development, representing different stakeholder types including health plans, providers, technology companies, government entities, trade associations, vendors, and standard-setting organizations.

There are several avenues through which organizations can contribute to development of the CAQH CORE Operating Rules:

  • Become a CAQH CORE Participating Organization: The most effective way for individual organizations to assure they have direct input on the development of operating rules is by becoming a CAQH CORE Participating Organization.
    • Participation in the CAQH CORE rules development process is open to any interested stakeholder, including health plans, providers, technology companies, government entities, trade associations, vendors, financial institutions, and standard-setting organizations.
    • Benefits available to CAQH CORE Participating Organizations include:
      • Participation on Subgroup/Work Group calls, straw polls, and eligibility to Chair groups
      • Organizational vote on CAQH CORE Work Group and Full CAQH CORE Voting Participating Organization levels
      • Access to CAQH CORE Education Sessions specific to CAQH CORE Participating Organizations
    • The cost of CAQH CORE Participation is extremely low or free; participants pay an annual fee based on the organization’s stakeholder type and net annual revenues. Refer to the CAQH CORE Participation Application for information on how to become a CAQH CORE Participating Organization.
  • Contribute as a Non-CAQH CORE Participating Organization: While only CAQH CORE Participating Organizations may vote directly on the CAQH CORE Operating Rules, Non-CAQH CORE Participating Entities can also indirectly contribute through public activities such as:
    • CAQH CORE national webinars: email core@caqh.org to be added to the distribution list.
    • CAQH CORE Industry Surveys: CAQH CORE periodically conducts industry-wide surveys to obtain directional feedback on operating rule opportunities; email core@caqh.org to be added to the distribution list.
    • Submit comments to CAQH CORE via email at core@caqh.org.

 


 [EW1]This website is super outdated – we should take it down and just direct to the education events page.

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