Payers Work to Ease Coordination of Benefits Determinations
Industry advocacy organization CAQH, which has developed the CORE operating rules to make HIPAA transactions more uniform, has a new initiative to streamline the coordination of benefits process.
Industry advocacy organization CAQH, which has developed the CORE operating rules to make HIPAA transactions more uniform, has a new initiative to streamline the coordination of benefits process.
All 12 health insurer members of CAQH have pledged to adopt the new COB process when it’s complete, which should happen later this year. Covering a combined 165 million members, the members are Aetna, AultCare, Blue Cross Blue Shield of Michigan, Blue Cross and Blue Shield of North Carolina, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Cigna, Health Net, Horizon Healthcare Services, Kaiser Permanente, UnitedHealth Group, and WellPoint and its affiliated plans.
The payers are building a shared repository of patient demographic data to match and compare records from different health plans to identify patients with overlapping coverage from more than one insurer. The goal is to electronically identify and assess payer responsibilities, a primarily manual and often inaccurate process, when a patient has coverage from more than one insurer.
The registry will be open to all commercial and government payers, says Robin Thomashauer, executive director at CAQH. The registry also is the latest initiative of the organization to reduce administrative complexities and costs in the transactions processing arena. In addition to the CORE initiative, CAQH also offers the Universal Provider Datasource, a database to share credentialing and other professional information among insurers and provider organizations; and a new electronic funds transfer enrollment tool to enable one-stop shopping for providers to enroll in EFT with health insurers.
All 12 health insurer members of CAQH have pledged to adopt the new COB process when it’s complete, which should happen later this year. Covering a combined 165 million members, the members are Aetna, AultCare, Blue Cross Blue Shield of Michigan, Blue Cross and Blue Shield of North Carolina, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Cigna, Health Net, Horizon Healthcare Services, Kaiser Permanente, UnitedHealth Group, and WellPoint and its affiliated plans.
The payers are building a shared repository of patient demographic data to match and compare records from different health plans to identify patients with overlapping coverage from more than one insurer. The goal is to electronically identify and assess payer responsibilities, a primarily manual and often inaccurate process, when a patient has coverage from more than one insurer.
The registry will be open to all commercial and government payers, says Robin Thomashauer, executive director at CAQH. The registry also is the latest initiative of the organization to reduce administrative complexities and costs in the transactions processing arena. In addition to the CORE initiative, CAQH also offers the Universal Provider Datasource, a database to share credentialing and other professional information among insurers and provider organizations; and a new electronic funds transfer enrollment tool to enable one-stop shopping for providers to enroll in EFT with health insurers.
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