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Clearinghouse is CORE-Certified
July 30, 2008
MD On-Line Inc., a Parsippany, N.J.-based claims clearinghouse, has been certified as in compliance with the CAQH Phase 1 standard for the eligibility verification and benefit determination transaction. CAQH, a Washington-based payer advocacy organization that includes other stakeholders, developed the standard.
CAQH’s Committee on Operating Rules for Information Exchange initiative, called CORE, seeks to reach consensus on more uniform versions of the HIPAA transactions. The goal is to eventually enable these transactions, such as claims, eligibility, claim status, preauthorization and remittance advice, to be conducted as easily as an ATM transaction.
CORE, comprising more than 100 industry stakeholders, has developed a Phase 1 standard eligibility/benefit determination standard. Several clearinghouses and insurers have been certified as meeting the standard. It is designed to give providers more consistent access to medical and pharmacy eligibility information at the point of care.
CORE is readying Phase II eligibility rules with additional requirements covering such areas as patient identifiers, deductibles and out-of-pocket limits, claims status, and connectivity. It expects later this year to begin certifying for compliance with Phase II eligibility, and start developing rules for other transactions.
More information is available at caqh.org and mdon-line.com.
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