Council for Affordable Quality Healthcare (CAQH)
CORE
CAQH’s Committee on Operating Rules for Information Exchange (CORE) initiative makes it possible for any provider to access consistent and reliable insurance coverage and payment information from any health plan electronically, using the technology of the provider’s choice. Through this national, all-payer, vendor-neutral solution, providers and health plans are accelerating the use of HIPAA transactions and other standards. They are also resolving data exchange challenges, such as patient identification, that impact all HIT efforts. Since its launch of initial rules in 2006, providers across the U.S. can now access health plan administrative data in real-time for over 63 million Americans, resulting in significant administrative cost savings. For eligibility alone, providers may reduce labor costs associated with verifying insurance coverage as much as 50 percent, and health plans avoid phone calls by increasing the use of automated transactions.
Results
- Blue Cross Blue Shield of North Carolina (BCBSNC) was one of the first CORE-certified health plans. They experienced a three-fold increase in the use of electronic eligibility and benefits verification transactions within 12 months of implementing the CORE rules, with the percentage of real-time transactions increasing from 20% to over 90%.
- Many of BCBSNC’s 44,000 providers have expressed satisfaction in this change given easier and faster access to patient coverage information in real-time.
- BCBSNC has seen faster implementations of electronic data exchange with provider and vendor trading partners due to more straightforward implementation of telecommunications, testing and data content.
- BCBSBNC is now requiring all of its vendor partners to become CORE-certified.
***Submitted by Gwendolyn Lohse, CORE Director, CAQH, Lohse, glohse@caqh.org
Published: January 26, 2009
