Providers who routinely verify patient insurance eligibility and benefits through electronic or other means experience higher rates of paid accounts. That is the key finding from a newly released study conducted by CAQH, a nonprofit alliance of health plans and trade associations.
The CORE Phase II Patient Identification Study was conducted by CAQH as part of its Committee on Operating Rules for Information Exchange (CORE) initiative. CAQH launched CORE to develop a set of universal operating rules aimed at simplifying communication and administrative processes between providers and health plans.
The study, which included inpatient facilities and ambulatory physician practices in California and New York, will be used to help create CORE Phase III operating rules aimed at improving patient identification. The goal is to develop rules for more flexible matching criteria, which will enhance automated, real-time processing of eligibility inquiries and responses.
