CAQH Committee on Operating Rules for Information Exchange (CORE)
CAQH is a non-profit alliance of health plans and trade associations dedicated to simplifying healthcare administration. The organization launched the Committee on Operating Rules for Information Exchange (CORE) with the vision of provider access to healthcare administrative information before or at the time of service using the electronic system of their choice for any patient or health plan.
HIMSS is proud to be a CORE Endorser and one of more than 100 industry stakeholders (health plans, hospitals, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and other healthcare entities) participating on CORE to help achieve that goal. CORE organizations collectively cover more than 130 million lives, or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.
Working in collaboration, participants are building consensus on a set of operating rules that:
- enhance interoperability between providers and payers
- streamline eligibility and benefits data transactions
- reduce the amount of time and resources providers spend on administrative functions.
Operating rules build on existing standards, such as HIPAA, to make electronic transactions more predictable and consistent, regardless of the technology.
To date, nearly fifty organizations are certified as complying with or endorsing the CORE rules, including HIMSS. Those rules enable providers to quickly access consistent electronic information for verifying:
- whether a health plan covers the patient
- patient benefit coverage
- coverage of certain treatments and the patients co-pay, coinsurance and base deductible (as defined in the member contract)
According to a recent CAQH study, providers may reduce labor costs associated with verifying insurance coverage as much as 50 percent by moving from labor-intensive verification methods (web, fax and phone) to automated HIPAA transactions. Health plans also could achieve significant labor savings, as the study showed that average labor costs per phone call are $1.38 vs. $0.00 for an automated transaction.
Several additional organizations are committed to completing the certification process by the end of 2007, and others are preparing for 2008/2009. The Initiative’s second set of rules, expected to be announced early in 2008, will address more complex eligibility components and claims status, both included under HIPAA.
HIMSS President/CEO H. Stephen Lieber affirms that, "CORE is making a significant contribution to the healthcare industry."
More information on CAQH and CORE:
CORE Overview Presentation - Other Pubs (2/23/2007)
CORE Participating Organizations - Other Pubs (2/23/2007)
CORE FAQs - Other Pubs (2/23/2007)
CORE Phase I Rules - Other Pubs (2/23/2007)
