Connectivity is essential for successful interoperability as it enables the transport of information to support data exchange. To address the industry’s need to align on a common set of communication protocols, CAQH CORE maintains a set of operating rules addressing connectivity and security of data exchange. CAQH CORE Participating Organizations are currently evaluating updates to the CAQH CORE Connectivity requirements to address existing and emerging standards and protocols to support the intersection of administrative and clinical data exchange.

On June 23, CAQH CORE staff will host a panel discussion featuring CAQH CORE Board members centered on key industry topics, including value-based payments, interoperability, and COVID-19.

Speakers:

Dr. Sue Turney (MGMA) President and CEO, Marshfield Clinic Health System

Tim Kaja Chief Operating Officer of UnitedHealth Networks, UnitedHealthcare

Dr. Marilyn Heine (AMA) Clinical Assistant Professor of Medicine, Drexel University College of Medicine

Join the CAQH CORE team for an update of current and ongoing initiatives to deliver administrative efficiency and value to the healthcare industry. Topics will include:   

The ASC X12N Health Care Services Review – Request for Review and Response (278) is a paired transaction set. This transaction set is also known informally by other names, such as Referral or Prior Authorization. The 278 is used throughout the healthcare marketplace by providers to electronically submit prior authorization and referral requests. CAQH CORE Operating Rules for Prior Authorization help the industry effectively utilize the 278 transaction to further standardize and automate components of the prior authorization process.

Register for this webinar to understand how pursuing CORE Certification can ensure your alignment with the CAQH CORE Operating Rules, many of which are federally mandated. Highlights will include:

CAQH CORE will provide an update on its 2020 goals and its ongoing initiatives to deliver administrative efficiency and value to the healthcare industry. Topics will include:   

CAQH CORE Participating Organizations are invited to join CAQH CORE leadership for a discussion on 2020 goals and priority initiatives. Topics covered will include:   

Plan to Cast Your Vote: The CAQH CORE Phase IV Work Group recently passed a ballot approving updates to the Phase IV 278 Infrastructure Rule. The next step in the CAQH CORE voting process is the Final Vote. CAQH CORE Participating Organizations are invited to join the Phase IV Work Group Co-Chairs for a review of the draft updates to the Phase IV 278 Infrastructure Rule which focuses on establishing maximum response timeframes at key stages in the prior authorization process, including a timeframe for final determination.

Electronic remittance advice (ERA) and electronic claim payment, also referred to as electronic funds transfer (EFT), work in tandem to enable automated reconciliation and communication of reimbursement. An ERA is an electronic explanation of payments made to the provider by the health plan and includes information about the patient, the service or procedure performed, the provider, and any claims adjustments.