Three insurers--Harvard Pilgrim Health Care, Aetna Inc. and WellPoint Inc.--have received certification for compliance with the second phase of the CORE initiative to standardize HIPAA administrative/financial transactions.
A handful of other payers expect to certify during the first quarter, says Gwendolyn Lohse, managing director of CORE and deputy director of CAQH, a Washington-based payer advocacy organization. CORE is the Committee on Operating Rules, a collaborative effort of industry stakeholders to reach agreement on far more unified format for electronic claims and related transactions. The goal of CORE is to reach industry consensus on transaction sets that will enable health care electronic data interchange transactions to be conducted as easily as an ATM transaction.
CORE started with Phase I of an electronic eligibility/benefit determination transaction. The recently completed Phase II of CORE further tightened the eligibility/benefit determination transaction and included claims status. Participants now are developing prior authorization and remittance transactions in Phase III.
Insurers already certified as able to conduct Phase I CORE transactions represent more than 70 million Americans, Lohse says. These insurers include private payers representing 75% of the commercially insured market, Medicare and a handful of Medicaid plans. More information is available at caqh.org.
Additional information on CORE will be available in an article on electronic data interchange trends in the February issue of Health Data Management.
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