CAQH's Committee on Operating Rules for Information Exchange (CORE) has created a set of operating rules to streamline eligibility and benefits data transactions between providers and payers. CAQH launched CORE to help answer a simple question: Why isn't verifying patient eligibility and benefits in provider settings as easy as making an ATM withdrawal?

This session will discuss how CORE's operating rules are building on the HIPAA 270/271 transactions to enhance health plan – provider system interoperability and streamline electronic data exchange. Attendees will receive a brief overview of the Phase I rules, the policies governing the exchange of eligibility and benefits data, and the CORE Phase I rules certification process.

CAQH also will present results from a recent survey on patient identification challenges, including potential savings from automated eligibility verification. Based on the survey findings, CORE is drafting Phase II rules on patient identification, which will be critical for streamlining patient matching processes. Attendees will have an opportunity to offer feedback on the draft patient identification rules and learn about a proposed follow-up study.