CAQH committee looks to broaden CORE governance

The Council for Affordable Quality Healthcare (CAQH) has launched a transition committee to make recommendations about multi-stakeholder governance of its Committee on Operating Rules for Information Exchange (CORE). The CORE project, which CAQH began in 2005, has created rules for the exchange of information related to healthcare coverage and insurance payments. CORE seeks to enable providers to obtain insurance information before or at the point of service, regardless of the billing system being used.

More than 120 industry organizations participate in CORE, including health plans covering 75 percent of commercial covered lives, plus Medicare, Medicaid, Tricare, the VA system, and agencies of several states. Up until now, health insurers and their trade associations have dominated the organization.

The decision to broaden the governance was made because of "the changing environment in which operating rules are mandatory," said Linda Fishman, senior vice president for public policy at the American Hospital Association and a member of the transition committee. "This change is critical to the CORE goal of aligning clinical and administrative simplification objectives. Most important though, is that broadening the perspectives at the table will help ensure that the operating rules reduce administrative costs for all and improve the workability of administrative processes for everyone. And the greater the standardization of processing, the easier it will be to achieve interoperability, especially as we move into an era of ever-increasing accountability."

The HIPAA 4010 transaction set standardized the exchange of administrative data--a process that will be taken further by the 5010 transaction set that goes into effect next year. But because of the myriad differences in provider, clearinghouse, and health plan information systems, the amount of data exchange has been limited and has often required "companion guides" to effectuate. The purpose of CORE is to  standardize the operating rules for information exchange in practice.

Among the members of the transition committee are Allscripts, America's Health Insurance Plans, the American Hospital Association, the American Medical Association, Blue Cross and Blue Shield of North Carolina, GE Healthcare, J.P. Morgan, Medical Group Management Association, the Minnesota Department of Health, Montefiore Medical Center, the National Governors Association, United Healthcare and WellPoint. 

To learn more:
- read the press release
- see the list of CORE members 

Related Content:
UnitedHealth Group is First to Achieve CAQH Core Certification Using 5010 Testing Platform
Payers setting own rules for sharing health information

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