UnitedHealth Group is First to Achieve CAQH Core Certification Using 5010 Testing Platform

  • 5010 data transactions include patient eligibility/verification and claim status
  • Faster and more predictable administrative transactions enable doctors and hospitals to spend more time caring for patients

MINNETONKA, Minn. & WASHINGTON--(BUSINESS WIRE)-- CAQH and UnitedHealth Group (NYSE: UNH) today announced that UnitedHealth Group has completed the Committee on Operating Rules for Information Exchange® (CORE®) Phase I and II testing process. This process certifies that UnitedHealth Group can deliver more efficient and predictable patient-eligibility and claims-verification information to doctors, hospitals, physician offices and other care providers, according to operating rules developed by CORE.

UnitedHealth Group is the first health care organization to complete certification using the updated platform, which builds on non-mandated aspects of the Health Insurance Portability and Accountability Act (HIPPA) version 5010 requirements. This is an important milestone in the company’s efforts to streamline patient-eligibility and claims status transactions, so that care providers can spend less time on administrative functions and more time treating patients.

The CORE operating rules streamline administrative information exchanges and improve provider access to patient benefits coverage and financial information at the point-of-care. CORE is a multi-phase, collaborative health care industry initiative aimed at improving access to electronic patient administrative and payer information for care providers before or at the time of service, using any technology. Each phase expands the available data criteria and augments the functional requirements for electronic data exchange.

“CORE certification reflects UnitedHealth Group’s commitment to streamlining administrative processes with doctors, hospitals and other care providers so they can spend more time providing quality care for their patients,” said Timothy Kaja, senior vice president, UnitedHealth Group Provider and Network Service Operations. “By becoming CORE certified, UnitedHealth Group is demonstrating that the concept of operating rules as mandated by the Patient Protection and Affordable Care Act (ACA) is an important part of making health care work better.”

“We are pleased that UnitedHealth Group is CORE certified. The operating rules will ensure an effective flow of administrative data between us,” said Murray E. Fox, M.D., FACOG, a Plano, Texas-based practicing physician and founder, president and CEO of Patient Physician Network, a 650-physician member network whose primary goal is to respond to the changing health care environment in the Dallas-Fort Worth area. “Being able to rely on UnitedHealth Group for consistent and accurate electronic information about benefits coverage and financial obligations enables us to streamline our internal processes and offer complete and timely information to our patients.”

Robin Thomashauer, executive director of CAQH, said: “We are pleased to see UnitedHealth Group join the growing number of companies that have become CORE certified and the first to become CORE certified in a 5010 format. Advances such as this are essential to establishing the foundation for true administrative simplification, leading to improved transparency and reduced cost in health care. Continued advances in CORE operating rules and adoption by companies such as UnitedHealth Group and its physician partners will accelerate our nation’s progress to that end.”

About CAQH and CORE

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.

A CAQH initiative, CORE has convened more than 120 health care 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. More information is available at www.caqh.org/benefits.php.

About UnitedHealth Group

UnitedHealth Group (NYSE: UNH) is a diversified health and well-being company dedicated to helping people live healthier lives and making health care work better. With headquarters in Minnetonka, Minn., UnitedHealth Group offers a broad spectrum of products and services through two distinct platforms: UnitedHealthcare, which provides health care coverage and benefits services; and Optum, which provides information and technology-enabled health services. Through its businesses, UnitedHealth Group serves more than 75 million people worldwide. Visit www.unitedhealthgroup.com for more information.


UnitedHealth Group
Tyler Mason, 714-226-3530
[email protected]
Miranda Woolston, 202-778-3224
[email protected]

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