CORE

CAQH CORE Participant List

Industry-led, CAQH CORE Participants include healthcare providers, health plans, vendors, government entities, associations and standard-setting organizations. Health plans participating in CAQH CORE represent 75 percent of the insured US population. We are working in collaboration to simplify administrative data exchange. Join us and become a CAQH CORE Participant today!

CAQH CORE Town Hall

CAQH CORE will provide an update of its work efforts and priority initiatives to deliver administrative efficiency and value to the healthcare industry. 


Register for this Town Hall to engage with CAQH CORE and provide input on how to best drive the industry towards fully digital business operations. For any questions, please contact CAQH CORE staff at CORE@caqh.org.

CAQH CORE Participant Forum

Plan to Cast Your Vote by Friday, December 4th: The CAQH CORE Connectivity & Security Work Group recently passed a ballot approving the draft CAQH CORE connectivity rule and the CAQH CORE Review Work Group approved a set of draft value-based payments rules focused on patient attribution. The next step in the CAQH CORE voting process is the Final Vote which opens on November 16th and closes on December 4th.

HIPAA Standards Exceptions Request Process

In a collaboration between the Centers for Medicare and Medicaid Services (CMS), WEDI and CAQH CORE, the CMS National Standards Group will provide an overview of the HIPAA Standards Exceptions Request Process to allow organizations to request an exception from the use of a standard from the HHS Secretary to test a proposed modification to that standard.

Following the presentation, time will be allocated for Q&A, with questions submitted prior to the webinar. Please submit your questions during the webinar registration process.

Prior Authorization Automation Case Study Webinar with Cleveland Clinic, PriorAuthNow and CAQH CORE

CAQH CORE, together with Cleveland Clinic and PriorAuthNow (PAN), is pleased to share initial findings highlighting the impact of greater prior authorization (PA) automation and workflow integration leveraging standards and operating rules at Cleveland Clinic. The Cleveland Clinic will share how the implementation of an integrated PA solution is improving the ability of staff to conduct PAs and creating a more efficient process.

Enhancing Industry Interoperability: CAQH CORE Connectivity Operating Rules

Connectivity is essential for successful interoperability as it enables the transport of information to support data exchange. To address the industry’s need to align on a common set of communication protocols, CAQH CORE maintains a set of operating rules addressing connectivity and security of data exchange. CAQH CORE Participating Organizations are currently evaluating updates to the CAQH CORE Connectivity requirements to address existing and emerging standards and protocols to support the intersection of administrative and clinical data exchange.

Conversation with CAQH CORE Board Members

On June 23, CAQH CORE staff will host a panel discussion featuring CAQH CORE Board members centered on key industry topics, including value-based payments, interoperability, and COVID-19.

Speakers:

Dr. Sue Turney (MGMA) President and CEO, Marshfield Clinic Health System

Tim Kaja Chief Operating Officer of UnitedHealth Networks, UnitedHealthcare

Dr. Marilyn Heine (AMA) Clinical Assistant Professor of Medicine, Drexel University College of Medicine