AUSTIN, Texas, Dec. 27, 2018 /PRNewswire-PRWeb/ -- A Healthcare Payer IT company announced today that it achieved the
Operating rules and underlying standards enable health plans, healthcare providers and vendors to electronically share large quantities of administrative data quickly, cost effectively and accurately. By specifying the business actions each party must follow in these transactions, the rules reduce costs and improve the efficiency of the nation's healthcare system.
The CORE Certification Seal was awarded after Eixsys, LLC successfully completed a thorough and independent testing process and a subsequent application review. This ensures that providers can gain access to a richer set of consistent and accurate electronic administrative data, such as eligibility, benefits, claims status and patient financial information from health plans following a common set of national operating rules.
"We at Eixsys recognize that complete automation of Administrative Simplification is achieved by not just adopting HIPAA standards, but by also implementing the standardization of end-to-end data exchange with meaningful content." Amin Salahuddin, President & CEO.
Phase II, CAQH CORE's second set of operating rules, builds and expands on Phase I to include more robust eligibility information and requirements to streamline the communication of claims status, including if a claim has been accepted, rejected, is incomplete or contains an error. The transactions are conducted in real-time, significantly reducing administrative work handling manual inquiries on eligibility and claim status.
According to CAQH research, manual processing for claim status inquiries costs the US health care system $9.65 per transaction. When conducting these transactions electronically, the cost drops to $1.67. The cost also goes significantly down for eligibility and verification transactions when conducted electronically—dropping from $7.20 to $.74. If both transactions were conducted only electronically, health plans and providers could save more than $6 billion annually.
"By adopting operating rules, demonstrating compliance and urging its business partners to do so as well, Eixsys, LLC is showing leadership in the industry," said Robin J. Thomashauer, CAQH President. "Operating rules are most effective when everyone follows them, and today, thanks to Eixsys, LLC our nation's healthcare system has taken another important step forward."
The U.S. Department of Health and Human Services selected CAQH CORE to develop national operating rules for HIPAA transactions to ensure that large amounts of data can be shared electronically in a fast and efficient way. Widely viewed as the industry "gold standard," the CORE Certification Program enables organizations to demonstrate that they and their business partners have adopted and are adhering to the operating rules and their underlying standards, plus going above and beyond what is required.
CAQH CORE is a multi-stakeholder collaboration of nearly 130 organizations that work together to develop operating rules. Participants represent healthcare providers, health plans, vendors, associations, government entities and the organizations that set standards for healthcare and data exchange. Four phases of CAQH CORE Operating Rules have been issued to date, and CORE Certification is currently available for Phases I, II, III and IV.
For more information on EIXSYS® Gateway email us firstname.lastname@example.org or visit http://www.eixsys.com.
To learn more about CAQH CORE, visit http://www.caqhcore.org.
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