Aetna Is First Health Insurance Carrier to Require CORE Certification for Its Data-Exchange Vendors |
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Written by U.S. Insurance News
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Friday, 15 February 2008 |
More than 25 prominent national health care organizations are certified by CORE (Committee on Operating Rules for Information Exchange). But only one of those companies—Aetna—has required all of its administrative data-exchange vendors to be certified in compliance with CORE rules.
More than 25 prominent national health care organizations are certified by CORE (Committee on Operating Rules for Information Exchange).
But only one of those companies—Aetna—has required all of its administrative data-exchange vendors to be certified in compliance with CORE rules, according to CAQH, a nonprofit alliance of health plans and trade associations that is working to streamline healthcare administration. Other companies may follow, but Aetna is the first.
"CORE represents the future of electronic administrative data exchange," explained Ronald A. Williams, CAQH chairman of the board and chairman and chief executive officer of Aetna. "We are proud to be the first to take this important step and call on organizations throughout the industry to improve healthcare by requiring CORE certification for their vendors."
CAQH launched CORE to create an all-payer solution that gives providers access to insurance information before or at the time of service using the electronic system of their choice for any patient or health plan. CORE rules make electronic administrative data communications seamless, streamlined and predictable. Providers can make transactions at a reduced cost, eliminate time-consuming administrative hassles for providers and health plans—such as the need to make phone calls and complete more paperwork—thereby improving the overall delivery of health care for patients.
A 2006 CAQH study showed that providers can reduce labor costs associated with verifying insurance coverage as much as 50 percent by moving from labor-intensive verification methods (Web, fax, and phone) to automated HIPAA transactions enabled by CORE. Health plans also can achieve significant labor savings, as the study showed that average labor costs per phone call are $1.38 versus nothing for an automated transaction.
Counting CORE-certified companies and those organizations that endorse the rules, CORE participants cover more than 130 million lives, or more than 75 percent of the commercially insured, plus Medicare and state-based Medicaid beneficiaries.
The national healthcare organizations that are CORE-certified can exchange select eligibility and benefits information with providers in compliance with the CORE Phase I Rules. Building on those rules, CORE's second set of rules provides guidelines for patient identifiers, patient accumulators, claims status, and connectivity. The Phase II rules also require reporting patient financial responsibility for an increased number of service codes. CAQH anticipates announcing Phase II certifications beginning at the end of Q3 2008.
CORE Phase III will focus on improving the electronic delivery of additional administrative transactions, such as prior authorization.
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