CAQH, an alliance of payers and trade associations that is overseeing development of the CORE operating rules to tighten HIPAA transactions, is moving to broaden the governance of the initiative.

Adoption of CORE rules now are voluntary, but the Affordable Care Act mandates adoption of a series of operating rules between 2013 and 2016, necessitating changes to increase multi-stakeholder governance. The federal government has not yet deemed CORE as the entity to develop the mandated operating rules, but the work continues to meet regulatory deadlines.

Following ACA's enactment a year ago, the CAQH board rescinded its right to veto operating rules approved by CORE participants, a right that was never exercised. Another present governance piece of CORE is its steering committee that develops strategic plans and guides workgroups. But the committee includes only representatives from four insurers, three software vendors, one provider (Montefiore) and one association (HIMSS).

CAQH as a result has launched a Transition Committee to make recommendations on expanding stakeholder governance of CORE. Members of the committee represent Allscripts, America's Health Insurance Plans, American Hospital Association, American Medical Association, Blue Cross and Blue Shield of North Carolina, GE Healthcare, J.P. Morgan, Medical Group Management Association, Minnesota Department of Health, Montefiore Medical Center, National Governors Association, UnitedHealthcare and Wellpoint.

More information is available here.

--Joseph Goedert


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