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Hospitals, Technology Vendors, Healthcare Organizations Join National Initiative to Write the Rules on Electronic Insurance Verification, Claims Status

Wednesday, November 28, 2007 General News J E 4
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WASHINGTON, Nov. 27 CAQH announced today that 12 of the nation's premier healthcare organizations have joined its Committee on Operating Rules for Information Exchange, CORE (http://www.caqh.org/CORE), the healthcare industry's leading initiative to simplify electronic patient administrative data exchange.



Cedars-Sinai Hospital System, ClaimRemedi, Enclarity, GE Healthcare, Harvard Pilgrim HealthCare, Healthcare Association of New York State, HealthCare Partners Medical Group, InstaMed, Minnesota Department of Human Services, New York-Presbyterian Hospital, RealMed Corporation, and Recondo Technology are CORE's newest members. They join the more than 100 other organizations (http://www.caqh.org/ben_participating.php) in developing the initiative's second set of business rules aimed at making patient eligibility and benefits verification as easy as an ATM transaction. The initiative's first phase rules were announced last year.



CORE's Phase II rules, expected to be announced early 2008, will help bring greater administrative efficiency to healthcare data transactions involving additional eligibility components (X12 270/271) and claims status (X12 276/277), both covered under HIPAA.



CORE participants collectively cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.



"CORE demonstrates what can be achieved through concerted industry collaboration," said Harry L. Reynolds, CORE chair and vice president at Blue Cross Blue Shield of North Carolina. "We are pleased to welcome these organizations to an effort that is transforming health plan-provider interoperability."



Built upon national standards, such as HIPAA, the CORE rules make electronic administrative data communications seamless, streamlined and predictable, regardless of the technology -- in many cases eliminating the need for time-consuming phone calls and paperwork. The vision for the CAQH initiative is to give 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.



According to a recent CAQH study, providers may reduce labor costs associated with verifying insurance coverage as much as 50 percent by moving from labor-intensive verification methods (web, fax and phone) to automated HIPAA transactions. Health plans also can achieve significant labor savings, as the study showed that average labor costs per phone call are $1.38 vs. $0.00 for an automated transaction.



"While others are talking about solutions, CORE is helping to implement positive change," said Peter Poleto, chief information officer for the Healthcare Association of New York State. "Our association of 550 non-profit and public hospitals, nursing homes, home care agencies, and other healthcare organizations like medical groups across the country can benefit greatly from participating in this important national effort."



Currently, more than 25 leading national healthcare organizations are CORE-certified and can exchange select eligibility and benefits information with providers in compliance with the CORE Phase I rules. Those organizations cover approximately 65 million or one-third of commercially insured lives in the U.S. Over 20 other healthcare associations, accrediting bodies, networks and businesses have endorsed the rules. CORE's newest endorser is the Electronic Healthcare Network Accreditation Commission, which signed the CORE Pledge this month.



CAQH launched CORE after completing a year of research with health plans, providers and industry leaders. The research showed that improved electronic access to accurate, timely healthcare administrative information, including eligibility and benefits data, would significa
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