BlueCross BlueShield of Tennessee has been certified as supporting Phase II of the CORE rules to significantly tighten the HIPAA financial/administrative transactions, according to CAQH, a Washington-based alliance of payers and trade associations.

CORE is the CAQH Committee on Operating Rules for Information Exchange initiative with the goal of making electronic claims and related transactions as easy to conduct as an ATM transaction. The health reform law mandates use of a series of operating rules between 2013 and 2016.

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 by including year-to-date deductibles among other functions, and also includes real-time claims status.

Other insurers that have received Phase II certification include Aetna, AultCare, Harvard Pilgrim Health Care, and WellPoint and its affiliate plans in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin.

Clearinghouses and vendors that are Phase II certified include ACS EDI Gateway, athenahealth, Availity, Capario, Emdeon, eServices Group, InstaMed, NaviNet, Post-N-Track, RelayHealth and Siemens/HDX.

CORE participants now are completing work on Phase III. This will include operating rules for infrastructure that supports referral requests, remittance advice, claims history availability, claim status content and acknowledgements, ID card specifications, and expanded eligibility and financial reporting.

More information is available at caqh.org/core.

--Joseph Goedert

 

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