Committee On Operating Rules For Information Exchange (CORE)
CAQH launched the Committee on Operating Rules for Information Exchange (CORE) with the vision of giving providers access to eligibility and benefits information before or at the time of service using the electronic system of their choice for any patient or health plan.
CORE is more than 130 industry stakeholders – health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and banking industry experts that maintain eligibility, benefits, and claims data for over 150 million commercially insured lives, plus the Medicaid eligibility processed by some of the plans and vendors, e.g. Unisys, and the Medicare beneficiaries. Working in collaboration, they are building consensus on a set of operating rules that will: Enhance interoperability between providers and payers Streamline eligibility, benefits, and claims data transactions Reduce the amount of time and resources providers spend on administrative functions – time better spent with patients Operating rules build on existing standards to make electronic transactions more predictable and consistent, regardless of the technology. Rights and responsibilities of all parties, security, transmission standards and formats, response time standards, liabilities, exception processing, error resolution and more must be clearly defined in order to facilitate successful interoperability. Beyond reducing cost and administrative hassles, operating rules foster trust among all participants.
Read more about this topic: CAQH
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