CORE Board has approved new rules to simplify
and speed up healthcare payments and claims, backed by strong
consensus from industry organizations.
WASHINGTON, April 30,
2024 /PRNewswire/ -- The CAQH Committee on
Operating Rules for Information Exchange (CORE) announces the
approval of three new and updated sets of CORE Operating
Rules aimed at simplifying healthcare payment and claims
processes for providers and health plans. Organizations can start
implementing these updates immediately to begin reaping the
benefits of streamlined processes and improved operational
efficiencies. This milestone reflects the collaborative efforts of
hundreds of industry participants who contributed through extensive
industry research, active work groups, and a formal ballot process.
This collective endeavor adds to the suite of existing CORE
Operating Rules and highlights industry commitment to reduce time
spent on administrative tasks and increase time for patient
care.
Erin Richter Weber, CAQH Chief
Policy and Research Officer stated, "These operating rules are
more than guidelines; when implemented, the rules streamline
healthcare data exchange and reduce provider burden. We are
grateful for the dedication and insight of all those who
contributed to this important work. This is a win for providers,
health plans, and, most importantly, patients."
What this means for the healthcare industry:
- For Value-Based Payments:
Standardizes the collection
of socio-demographic data and terminology, improving data
quality for contracts and easing program management. Also enables
providers to address social health determinants through a
dependable information-sharing system with value-based care
partners.
Streamlines coding for telehealth and
value-based payments, standardizes diagnosis communication, and
improves benefits coordination, reducing errors and simplifying
processes.
- For Electronic Payments and Processing:
Adds critical data elements,
enhances fraud detection, and increases
transparency by disclosing fees and opt-out options for alternative
payment methods.
These updates have garnered significant support across the
industry, with approval rates of 86% and higher during the formal
CORE Participant Voting Process.
Linda Reed, SVP and CIO of St.
Joseph's Health and CORE Board Chair, shared her perspective
on the significance of the new and updated rules, "The unanimous
approval of these operating rules by the plans, providers, and
vendors on the CORE Board underscores our commitment to improving
healthcare administration. By adopting these rules, we are taking a
significant step forward in reducing administrative burdens and
enhancing the efficiency of healthcare transactions."
Healthcare operating rules support a range of standards to make
sharing data more predictable and consistent, regardless of the
technology. CORE is designated by the Secretary of the Department
of Health and Human Services (HHS) as the National Operating Rule
Authoring Entity for the administrative transactions under HIPAA.
CORE is committed to bringing together industry stakeholders to
develop and implement operating rules that foster a more efficient
healthcare system. Entities that are already CORE-certified will
have a two-year period to integrate these new rules into their
systems. For more detailed information including implementation
resources, please refer to the official CORE Operating Rules
website.
About CAQH
CAQH is a leading organization focused on aligning the
healthcare ecosystem around essential solutions, creating a more
connected and less costly experience for all. For more than 20
years, CAQH has partnered with millions of providers, thousands of
health plans, state Medicaid agencies, and leading healthcare
stakeholders who leverage the organization's solutions, operating
rules, and insights to connect and exchange data every day as a
part of the business of healthcare. Learn more at CAQH.org.
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SOURCE CAQH