Nearly 600,000 Providers Nationwide Can Access Streamlined Eligibility and Benefits Data From One of the Nation's Largest Plans
WASHINGTON, May 26 /PRNewswire/ -- CAQH® announced today that CIGNA has earned certification for electronically exchanging administrative data, for more than 11 million medical customers, using the CAQH Committee on Operating Rules for Information Exchange® (CORE®) Phase I operating rules. The CORE rules are improving the flow and data content of administrative exchanges between providers and health plans.
CIGNA joins 50 organizations or products that have adopted these voluntary, industry-wide operating rules. CORE Phase I-certified health plans cover more than 85 million lives, or roughly 40 percent of the commercially insured. Hospitals, physicians and healthcare professionals in the CIGNA network now have improved real-time access to patient eligibility and benefits data. This streamlined approach to accurate and consistent information enables more time for physicians and other healthcare professionals to focus on patient care.
"CIGNA is pleased to achieve CORE certification, as these rules improve the information flow between us and the healthcare professionals in our networks, leading to more efficient and cost-effective administration," said Dr. Alan Muney, CIGNA senior vice president, total health and network. "This is just one of the ways we are working to be the partner of choice for healthcare professionals and to improve the experience of the people we serve."
In the effort to enhance operations and encourage widespread adoption of the rules, CIGNA is encouraging its trading partners to become CORE-certified. Access to eligibility and benefits data is improved with every organization that completes the certification process.
"Achieving CORE Phase I certification positions CIGNA as a leader in bringing interoperability to healthcare. Changing its daily business practices to streamline administrative processes for providers will result in tremendous savings both in time and resources. This is ultimately leading to an improved consumer experience," said Marilyn Miceli, vice president, managed care, Memorial Healthcare System, Ft. Lauderdale, Florida.
The CORE rules complement the approaches outlined by the Federal Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of the American Recovery and Reinvestment Act (ARRA). Additionally, these operating rules incorporate requirements for items such as adopting standards and requiring data delivery in real-time, making CORE well aligned with other national health information technology efforts.
The objectives to generate cost savings, promote the adoption of a single set of rules, and enhance interoperability in healthcare are inherent to CORE. In order to achieve these objectives, the CORE rules include both infrastructure and data content requirements that assist with securely streamlining electronic patient data exchanges across the wide range of current information technology systems.
About the Committee on Operating Rules for Information Exchange (CORE)
CAQH launched the multi-phase CORE initiative approximately five years ago. CORE is focused on improving provider access to electronic patient administrative and payer information before or at the time of service, using any technology. The CORE rules actively support privacy/security practices and build upon national standards, such as the Health Insurance Portability and Accountability Act. Each phase expands the available data criteria and augments the functional requirements for electronic data exchange.
CAQH has convened more than 115 healthcare industry stakeholders as participants in developing the CORE rules. Participating health plans cover more than 150 million lives or approximately 75 percent of the commercially insured plus Medicare and state-based Medicaid membership. CORE participants are developing the Phase III rules, which build upon the Phase I and Phase II rules that are being implemented in the market today. The third set of rules focuses on improving the electronic exchange of additional administrative transactions, such as prior authorization and remittance advice.
A study by IBM Global Business Services found that industry-wide implementation of the CORE Phase I rules alone could yield $3 billion in healthcare savings in three years. Widespread adoption of the Phase II rules and subsequent phases of CORE will result in even greater savings throughout the healthcare industry. View www.caqh.org/CORE_overview.php for more information.
CAQH serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. CAQH solutions help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration, facilitate administrative healthcare information exchange, and encourage administrative and clinical data integration. Visit www.caqh.org for more information.