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Patient Deductible Data |
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CAQH Initiative Creates First-Time
National Provider Access to Consistent Patient Deductible Data,
Moves Industry Closer to Electronic Connectivity Standard
Other Topics: Intensity-Modulated
Radiotherapy (IMRT),
Medical
Informatics Major
CAQH
September 15, 2008
Nearly 30 Leading Healthcare Organizations Commit to Using
Newly-Released CORE Phase II Rules
WASHINGTON - CAQH announced today that for the first-time
providers will be able to receive consistent electronic
information about patient deductible balances from potentially
any health plan at the point of care.
This achievement is the result of voluntary business rules
developed during the second phase of activities conducted by the
CAQH Committee on Operating Rules for Information Exchange
(CORE), a collaborative healthcare industry initiative. |
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CAQH, a nonprofit alliance of health
plans and trade associations working
to streamline healthcare administration, launched the
multi-phase program in
2005. CORE is focused on improving provider access to electronic
patient
administrative and payer information before or at the time of
service using
any technology they choose. The CORE rules build upon national
standards, such
as HIPAA. Each phase expands the pool of available data and
augments the
functional requirements to exchange it electronically.
"Today's announcement further demonstrates that CORE is
transforming the
way our industry communicates," said Ronald A. Williams, CAQH
chairman of the
board and chairman and CEO of Aetna. "With the Phase II rules
now in place and
work begun on Phase III, CORE is effectively achieving its
mission to create
an all-payer approach to streamlined administrative data
exchange."
Through CORE, CAQH has brought together more than 100 healthcare
industry
stakeholders as partners in rules development. Health plans
participating on
the committee cover more than 130 million lives or more than 75
percent of the
commercially insured plus Medicare and state-based Medicaid
beneficiaries.
The Phase II rules also cover requirements for electronic
connectivity,
patient identification, claims status and reporting of patient
financial
responsibility for an increased number of service codes included
in the HIPAA
standards. CORE's second set of rules builds on the rules
created by the
initiative during its Phase I efforts, completed in 2006. Both
phases are
advancing health plan-provider system interoperability.
"CAQH CORE standards reduce costs and enhance efficiency by
connecting
payers, providers and patients with the data they need to
support the
administration of healthcare," said John Halamka, Healthcare
Information
Technology Standards Panel (HITSP) Chairman, and Chief
Information Officer,
Harvard Medical School and Beth Israel Deaconess Medical Center.
CAQH also announced that more than 25 leading health plans,
large provider
groups and technology vendors are committed to completing Phase
II rules
certification testing by the end of 2009. These stakeholders --
currently
certified as complying with the CORE Phase I rules -- include:
Aetna Inc.;
AultCare Corporation; WellPoint, Inc. and its 14 BCBS-licensed
subsidiaries;
Mayo Clinic; Montefiore Medical Center; Affiliated Computer
Services, Inc.;
Availity, LLC; Emdeon Business Services; HMS; MedAvant
Healthcare Solutions;
MedData; NaviMedix, Inc.; Passport Health Communications;
Post-N-Track;
RelayHealth; Siemens Medical Solutions; athenahealth, Inc.; CSC
Consulting,
Inc.; Emerging Health Information Technology; GE Healthcare;
Medical
Informatics Engineering, Inc.; NoMoreClipboard.com; The SSI
Group, Inc.; and
VisionShare, Inc.
Harvard Pilgrim Health Care and Ingenix have committed to
achieve CORE
Phase I and II rules certification by the end of next year.
BlueCross BlueShield of Tennessee; Health Net, Inc.; Humana Inc.
and
SureScripts-RxHub will become CORE Phase II rules certified by
the end of the
first quarter in 2010.
Entities must complete a testing process to confirm that their
systems
and/or products comply with the CORE rules. Phase I
certification is required
prior to completing Phase II certification. The CORE rules now
allow for
entities to complete Phase I and II certification testing during
a single,
integrated process.
More than 20 healthcare associations, accrediting bodies,
networks and
businesses have committed to endorsing the CORE Phase II rules.
The Blue Cross and Blue Shield Association expressed its support
for the
initiative with the following statement: "BCBSA is pleased to
participate in
CAQH CORE's efforts to streamline electronic eligibility.
Simplifying provider
access to patient insurance coverage information is critical and
the Blues
believe that CORE is a key initiative to bring the industry
together for
collaboration and consensus building."
CORE is currently determining the scope of issues it will create
rules for
during its third phase. Issues under consideration include
determining in- or
out-of-network status of a provider, alternative search
requirements for
eligibility transactions when some member ID information is
missing,
coordination of benefits, claims attachments and harmonizing
CORE with other
industry standardization efforts.
About CAQH
CAQH serves as a catalyst for industry collaboration on
initiatives that
simplify healthcare administration for health plans and
providers, resulting
in a better care experience for patients and caregivers. CAQH
solutions help
promote quality interactions between plans, providers and other
stakeholders,
reduce costs and frustrations associated with healthcare
administration,
facilitate administrative healthcare information exchange and
encourage
administrative and clinical data integration. Visit
http://www.caqh.org for
more information.
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