CAQH CORE Operating Rules: Helping You Streamline Payments and Reconciliation
Erin Richter Weber
CORE Senior Manager
Senior Manager, CORE
Current, federally-mandated CAQH (Council for Affordable Quality Healthcare) CORE (Committee on Operating Rules for Information Exchange) Operating Rules cover eligibility, claim status, EFT, and ERA transactions. The operating rules help promote greater uniformity in how administrative healthcare data is exchanged electronically between health plans and providers.
However, industry statistics show there is still some confusion among provider organizations regarding their roles versus contracted vendors during the implementation of these operating rules, as well as how providers can fully realize the benefits of the operating rules.
This webinar provides healthcare finance professionals the information and tools necessary to navigate the barriers of, successfully implement, and comply with the CAQH CORE operating rules. The webinar also reviews the fundamentals of operating rules such as key terms and definitions, the impact on providers, ROI in terms of improved point-of-service collections, reduced cost-to-collect, and efficiencies in payment posting, and steps providers should take to ensure they are benefitting from the operating rules.
After This Webinar You'll Be Able To:
- Summarize the CAQH CORE operating rules and how they relate to the Affordable Care Act
- Cite examples of what the operating rules address
- Explain how ACA-mandated operating rules impact provider organizations including:
- Implementation requirements
- Coordination with trading partners
- Benefits, such as impact on the revenue cycle
- Identify CAQH CORE implementation resources
Tools & Takeaways
- CAQH CORE and operating rules FAQ
- CAQH CORE resources available to help organizations meet the Patient Protection and Affordable Care Act's operating rule mandate
Mid to upper-level managers (directors, CFOs, CEOs, etc.) with provider organizations responsible for revenue cycle management (billing, collections, etc.), EDI transactions, and project management who are interested in learning about how they can take advantage of the operating rules to affect changes in quality and cost effectiveness.
Field of Study: Specialized Knowledge and Applications
Delivery Method: Group Internet
Prerequisites: Some knowledge of HIPAA and the Affordable Care Act
Contact hours: 1.0
HFMA members: Free
Note: This on-demand webinar is available until Oct. 22, 2015.