Insurer UnitedHealth Group is the first health care organization to certify compliance with CORE operating rules in the HIPAA 5010 transaction sets format.
CORE is the Committee on Operating Rules for Information Exchange initiative within CAQH, an alliance of payers and trade associations. Industry stakeholders are cooperating to develop operating rules to tighten the HIPAA standards for claims and related administrative/financial transactions to make the transactions more uniform among providers, payers and vendors. The Affordable Care Act mandates development and adoption of a series of operating rules through 2016.
UnitedHealth has certified compliance, in a 5010 environment, with Phases I and II of CORE, which cover eligibility verification/benefit determination and claim status transactions. More information on CORE is available at caqh.org/core.
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