Twenty health plans, clearinghouses, providers and health information technology vendors have achieved or will certify their implementation of the CAQH Committee on Operating Rules for Information Exchange (CORE) Phase II rules. Increased adoption of enhanced administrative data exchange and interoperability rules is likely to generate savings, say CAQH officials.


"AultCare believes the CORE rules are a critical component for increased efficiency in our vertically integrated health system and for improving the quality of care for our community," said Rick L. Haines, president and CEO of AultCare, and CAQH board member. "This is one aspect of our commitment to increase efficiency and quality, by helping our providers get access to the information they need to make the best healthcare decisions." Recently, six organizations joined CORE as participants, three others have endorsed and another four achieved Phase I certification.


This accomplishment is the result of the widespread voluntary adoption of business rules being developed by CORE. The CORE rules are streamlining the exchange of administrative data, which is resulting in improved access to coverage and financial information by providers at the point-of-care. Certified organizations complete a testing process to confirm that their systems or products comply with both the CORE infrastructure and data content rules. 
The Phase II rules address requirements for electronic connectivity and digital certificates, patient identification, real-time claims status and reporting of year-to-date deductibles. Each phase is designed to build upon earlier phases and is aligned with Federal interoperability efforts.

The organizations that have achieved CORE Phase II certification include health plans collectively serving more than 53 million people: Aetna; AultCare; Harvard Pilgrim Health Care; WellPoint, Inc. and its affiliated health plans in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin.


Clearinghouse and health information technology vendors accomplishing CORE Phase II certification are ACS EDI Gateway, Inc.; athenahealth, Inc.; Availity, LLC; Capario; Emdeon Inc.; eServices Group Inc.; InstaMed; NaviNet, Inc.; Post-N-Track Corp.; RelayHealth; and Siemens/HDX. AvMed Health Plans; Gateway EDI; Medical Present Value, Inc. (MPV); and Office Ally recently achieved CORE Phase I certification.

These organizations are now applying the CORE rules to all of their transaction-based work.