CAQH CORE announced that it has awarded more than 300 CORE Certifications to health plans, hospitals and health systems, clearinghouses and vendors with recent Aetna and Cigna awards. The continued increase in the number of organizations seeking and receiving certification underscores the value they place on demonstrating that they meet – and exceed – the CORE operating rules and underlying standards for electronic business transactions.  

More than 1.4 million healthcare providers currently enter and maintain a wide range of information within CAQH ProView®, the industry’s trusted electronic solution for capturing and sharing self-reported provider data. Providers and practice managers enter data free-of-charge into the secure central database and authorize healthcare organizations to access the information, eliminating redundant paperwork and reducing administrative burden.  User feedback is crucial to drive innovation and enhance developing and existing features to optimize CAQH ProView. Various outreach activities are conducted throughout the year to ensure that ideas and suggestions from healthcare providers and health plans are integrated into the solution.

A new two-minute video by CAQH Commitee on Operating Rules for Information Exchange (CORE®) provides an overview of CORE Certification. This e-program enables entities to demonstrate that they are adhering to the CAQH CORE Operating Rules and underlying standards for administrative data sharing across the healthcare system. Developed by industry for industry, the CORE Certification program is widely recognized as the industry gold standard for testing conformance to the operating rules.  

From greater implementation of the CAQH CORE operating rules to research on the operational needs of the industry to support value-based payments, CAQH CORE continues to identify and implement opportunities that drive the industry toward true interoperability and electronic data exchange. These topics, among others, were highlighted in a recent Town Hall webinar in which CAQH CORE provided progress updates and discussed initiatives underway to enhance the exchange of electronic data in healthcare business transactions.

[[{"fid":"4865","view_mode":"default","fields":{"format":"default","field_file_image_alt_text[und][0][value]":"","field_file_image_title_text[und][0][value]":"","field_folder[und]":"255","field_binary_asset_section[und]":"117","field_public[und]":"1","field_file_description[und][0][value]":"","field_file_description[und][0][format]":"full_html"},"type":"media","prev_link_text":"","attributes":{"style":"height: 400px; width: 600px;","class":"media-element file-default"}}]] [[{"fid":"4868","view_mode":"default","fields":{"format":"default","field_file_image_alt_text[und][0][value]":"","field_file_image_title_text[und][0][value]":"","field_folder[und]":"255","field_binary_asset_section[und]":"117","field_public[und]":"1","field_file_description[und][0][value]":"","field_file_description[und][0][format]":"full_html"},"type":"media","prev_link_text":"","attributes":{"style":"height: 399px; width: 600px;","class":"media-element file-default"}}]] More than 100 industry leaders from health plans, healthcare provider organizations, government, consumer groups and others participated in a CAQH-convened Summit on Sept. 29th to develop a path forward for solving healthcare provider data challenges. The discussion was informed by the CAQH White Paper describing the current state of provider data accuracy and efforts to maintain reliable, high-quality data. Keynote speaker Shantanu Agrawal, M.D. (pictured above), deputy administrator and director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services, and panelists throughout the day, highlighted areas of concern and described why there is an imperative to address these challenges now. Common themes included the rising costs of healthcare, an evolving provider landscape, new uses for data—such as testing new payment models—and a growing regulatory environment.

Health plan business partners increasingly recognize that, by becoming CORE-certified, they can help their clients meet requirements under the Affordable Care Act (ACA) to conduct secure and efficient administrative data exchange. Business partners may include vendors, clearinghouses, third party administrators (TPAs) and other entities that help health plans and healthcare providers process transactions more efficiently.

Responding to consumer concerns about the quality of healthcare provider directories, a number of federal and state directory requirements have recently gone into effect. Health plans must now regularly update and confirm the accuracy of their provider information, or face potential penalties. CAQH is helping health plans address these requirements with the launch of DirectAssure, which works in concert with CAQH ProView to improve provider directory data.

CAQH CORE recently announced that it has awarded more than 200 CORE Certifications. Created and maintained with broad multi-stakeholder input, the CORE Certification program works with independent testing entities to evaluate whether organizations applying for certification use information systems that conform to the standards and operating rules. 

At the inaugural hearing of the Affordable Care Act (ACA)-mandated Review Committee in June, CAQH CORE presented compelling testimony that operating rules have resulted in significant contributions to the business needs of the healthcare industry. CAQH CORE also emphasized that many opportunities still exist to use operating rules to achieve interoperable data exchange.