More than 20 leading healthcare organizations have taken a major step toward easing the burden that physicians and other providers face in verifying patient insurance information. The groups, including Aetna, Humana, and WellPoint, have agreed to exchange eligibility and benefits information electronically according to rules developed through the Council for Affordable Quality Healthcare, a not-for-profit alliance of leading health plans. The operating rules, developed by the CAQH Committee on Operating Rules for Information Exchange (CORE), build on existing standards, such as those in the Health Insurance Portability and Accountability Act, to make electronic transactions more efficient, predictable, and consistent, regardless of the technology. Insurance verification also is critical for effective upfront collections and price transparency.
Bob Greczyn, CAQH board chair and CEO and president of Blue Cross and Blue Shield of North Carolina, called the commitment to follow the CORE rules “the first wave of an industry campaign to reduce an unnecessary administrative burden related to verifying patient insurance coverage.” Nearly 70 million Americans are covered by the health plans that have committed to use the CORE Phase I rules by March 2007. HFMA is among 19 organizations that have endorsed the CORE Phase I rules.
The CORE operating rules will help providers determine whether a health plan covers the patient, the level of patient benefit coverage, and the patient’s copay amount, co-insurance level, and base deductible levels. The rules also establish policies governing the exchange of data. The CORE initiative will create operating rules to address additional eligibility components and business transactions in Phase II (2006-07) and later phases (2007and beyond). Read the news release.
