The CORE Council has approved new rules to simplify and expedite health care claims and payments, with the support of a strong consensus from industry organizations.
WASHINGTON, April 30, 2024 /PRNewswire/ — CAQH’s Committee on Operating Rules for the Exchange of Information (CORE) announces the approval of three new and updated sets of Core Operating Rules intended to simplify the payment and assistance claims processes healthcare for providers and health plans. Organizations can begin implementing these upgrades immediately to begin reaping the benefits of streamlined processes and improved operational efficiency. This milestone reflects the collaborative efforts of hundreds of industry participants who contributed through extensive industry research, active working groups and a formal voting process. This collective effort adds to the existing CORE series of operating rules and highlights the industry’s commitment to reducing time spent on administrative tasks and increasing time for patient care.
Erin Richter WeberCAQH’s director of policy and research stated, “These operational rules are more than guidelines; when implemented, the rules streamline the sharing of healthcare data and reduce provider burden. We appreciate your dedication and vision of all those who have contributed to this important work. This is a win for providers, health plans and, most importantly, patients.”
What this means for the healthcare sector:
- For value-based payments:
It standardizes the collection of socio-demographic data and terminology, improving the quality of contract data and facilitating program management. It also enables providers to address the social determinants of health through a reliable system of information sharing with value-based care partners.
It streamlines telehealth coding and value-based payments, standardizes diagnostic communication, and improves benefit coordination, reducing errors and simplifying processes.
- For electronic payments and processing:
Add critical data elements, improve fraud detection and increases transparency by disclosing fees and opt-out options for alternative payment methods.
These updates have garnered significant support across the industry, with approval rates of 86% or higher during the formal voting process by CORE participants.
Linda ReedSVP and CIO of St. Joseph’s Health and CORE Board Chair, shared his perspective on the importance of the new and updated rules: “The unanimous approval of these operating rules by plans, providers and vendors on the CORE Board underscores the our commitment to improve healthcare administration With the adoption of these rules, we are taking an important step to reduce administrative burdens and improve the efficiency of healthcare transactions.”
Healthcare operational rules support a range of standards to make data sharing more predictable and consistent, regardless of technology. CORE is designated by the Secretary of the Department of Health and Human Services (HHS) as the authorizing entity for the national operating rule for administrative transactions under HIPAA. CORE is committed to bringing industry stakeholders together to develop and implement operating standards that foster a more efficient healthcare system. Entities that already have CORE certification will have a period of two years to integrate these new rules into their systems. For more detailed information, including implementation resources, see the official CORE Operating Rules website.
About CAQH
CAQH is a leading organization focused on aligning the healthcare ecosystem around essential solutions, creating a more connected and less expensive experience for everyone. For more than 20 years, CAQH has partnered with millions of providers, thousands of health plans, state Medicaid agencies and major healthcare stakeholders who leverage the organization’s solutions, operating rules and insights to connect and exchange data every day as part of the business of healthcare. Learn more at CAQH.org.
SOURCE CAQH
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