CORE rules agreed on by IT vendors and providers

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Numerous healthcare providers and hospitals have signed on to support and use new standard business rules developed by the CAQH Committee on Operating Rules for Information Exchange (CORE). The rules can assist providers’ to access in seconds consistent eligibility and benefits information required to verify patient health insurance coverage.

The CORE rules build on HIPAA eligibility transaction, and help to make electronic administrative data communications as streamlined and predictable as possible no matter what type of system is used.

Nearly 20 leading health organizations recently completed CORE certification testing, a process ensuring that their IT systems and products comply with the CORE rules. SSI Group Inc. was the first healthcare organization to receive CORE certification seals. Now over 50 million Americans are covered by the health plans using the CORE rules.

The recent companies signing on include ACS EDI Gateway Inc.; Aetna, Inc.; athenahealth Inc.; AultCare Corporation; Emdeon Business Services; Emerging Health Information Technology; Health Net; HTP Inc.; Mayo Clinic; McKesson Provider Technologies; MedAvant Healthcare Solutions; Medical Informatics Engineering, Inc. (MIE); Montefiore Medical Center; NaviMedix, Inc.; Passport Health Communications; Siemens Medical Solutions; and WellPoint Inc., along with its 14 Blue Cross and Blue Shield-licensed subsidiaries.

Several other healthcare entities, including Blue Cross and Blue Shield of North Carolina; Blue Cross and Blue Shield of Tennessee; GHN-Online; Health Plan of Michigan; MedData;; the U.S. Department of Veterans Affairs; and VisionShare Inc., are committed to CORE rules compliance by no later than June 30, 2007.