Seamless Information Sharing:  The Lifeblood of our Healthcare System

GwenBy Gwen Lohse

Whether it’s business, sports, or driving your car, everything works better when everyone follows the same rules.  Nowhere does this apply more than in the exchange of healthcare administrative data.

In 2010, the Affordable Care Act (ACA) mandated HHS develop operating rules to enhance data sharing across the healthcare system, and to develop a certification program to enforce it.  The Secretary of HHS turned to CAQH CORE, a collaboration of public and private organizations across healthcare, to write the operating rules and underlying standards. 

Today, CAQH CORE offers a certification program to enable entities to prove that they are following the rules.  So far, CAQH CORE has awarded more than 300 certifications,  a number that’s growing monthly. For the initial phase of Certification, health plans that represent over 60 percent of both commercially and publically insured became certified, including 16 Medicaid agencies.

That’s good news.  Widespread adoption of CORE Certification by all participants in the flow of healthcare administrative information is essential to achieve our nation’s goals of interoperability and efficiency.

And the momentum is growing.  Health plans and hospital systems are increasingly relying on clearinghouses, third party administrators and other vendors to transmit, warehouse and manage data.  Many of these vendors and clearing houses are seeking CORE Certification to help their health plans, health systems, and providers meet the ACA mandate.  This multi-stakeholder collaboration improves operations and saves money for everyone involved. 

According to Carroll Midgett, Chief Operating Manager, American Postal Workers Union, Health Plan, “The business of healthcare is now highly interdependent. Widespread adoption of CORE Certification by all participants in the flow of healthcare administrative information is essential to achieve our nation’s goals of interoperability and efficiency, and we expect our business partners to be CORE-certified.”

In this respect, healthcare is a behind financial services and other sectors.  Banks have been using following a strict set of standards and operating rules for years.  But with the rapid growth of CORE Certifications, the industry is clearly catching up.

To view a complete list of CORE Certified organizations click here.

Gwendolyn Lohse serves as the Deputy Director, Managing Director for the Committee on Operating Rules for Information Exchange (CORE) at CAQH. CAQH CORE creates national business rules to govern the electronic exchange of administrative data, regardless of technology. To demonstrate their adoption of the CAQH CORE Operating Rules, entities must complete a certification process that verifies that their IT systems and products are in compliance with the rules.

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