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: CAQH CORE Policy Brief
Updated: November 7, 2011
Background:
CAQH is the Council for Affordable Quality Healthcare. They are a nonprofit alliance of health plans and trade associations (Big plans like the Blues, United, Aetna WellPoint, etc. are members as well as AHIP). CAQH serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers to effectively support the delivery of care.
The CORE initiative through CAQH is the Committee on Operating Rules for Information Exchange (CORE). CORE brings together more than 100 industry stakeholders to develop an all-payer solution that enables consistent provider access to healthcare administrative information before or at the time of service using their choice of electronic system.
How this relates to MMS and claims transactions:
There has been a large push for administrative simplification throughout several federal healthcare reform initiatives. The concept of operating rules was addressed in the Affordable Care Act (ACA) in section 1104, which focuses on administrative simplification. It specifically requires the Secretary to adopt and regularly update standards, implementation specifications, and operating rules for the electronic exchange and use of health information for the purposes of financial and administrative transactions.
On Sept 30, 2010, the National Committee on Vital and Health Statistics (NCVHS) provided a letter of advice and recommendations to HHS relative to Sec 1104 of ACA. For operating rules for eligibility and claim status transactions, NCVHS provided observations and recommendations on (1) naming operating rules authoring entities, (2) adopting operating rules for eligibility and claim status transactions, (3) content of operating rules, (4) uses of companion guides, (5) coordination between operating rules authoring entities and standards development organizations, and (6) certification of compliance with operating rules.
NCVHS recommended that CAQH CORE, and the National Council for Prescription Drug Programs (NCPDP), be named authoring entities. In addition, NCVHS recommended that HHS adopt CAQH CORE Phase I and Phase II operating rules for non-retail pharmacy eligibility and claim status transactions.
On April 25, 2011, CORE announced that a Transition Committee has been launched to make recommendations regarding multi-stakeholder governance of CORE. The Transition Committee was formed as part of a 2010 commitment made by the CAQH board to increase industry participation in operating rules development and adoption. The Committee is charged to develop a three-year governance plan that outlines structure and revenue models for CORE. It is anticipated that the Committee will complete its work and implement its recommendations by the fourth quarter of 2011.
CORE Phases Overview
COREs Phase I rules CORE Phase I rules cover a number of key eligibility and benefits data elements and the processes required to exchange them. They are helping providers determine whether a health plan covers the patient, determine patient benefit coverage, and confirm coverage of certain treatments and the patients co-pay amount, coinsurance level and base deductible levels (as defined in the member contract) for each of those types. Phase I rules and policies developed to govern exchange of this data include:
System connectivity
Standard inquiry acknowledgements
Maximum response times (batch and real-time)
Minimum hours a system must be available
Standard 270/271 companion guide flow and format
Standard testing, certification and enforcement processes to ensure operation in accordance to the CORE rules
COREs Phase II Rules CORE Phase II Rules build on those rules created in Phase I. The Phase II rules add several new rules and require reporting of patient financial responsibility for an increased number of service codes. Phase II rules developed to streamline data content and govern the exchange of administrative data include:
Patient identification
Patient accumulators
Claims status
Connectivity
In anticipation of the industry moving from HIPAA Version 4010 to Version 5010, CORE Phase I and Phase II rules incorporate many of the features found in the X12 5010 TR3s to address the common information needs for patient eligibility.
CORE Phase III Rules Work on the Phase III rules is underway. Phase III rules will focus on improving the electronic delivery of additional administrative transactions, such as prior authorization and remittance advice. Rule writing for all areas takes into consideration any related 5010 requirements.
Eligibility and Claim Status Operating Rules Status - Progress to Date (November 2011)
June 2011 Interim Final Rule (IFC) proposes adoption of Phase I and Phase II CAQH CORE, except for acknowledgements; highlights CORE Certification is voluntary
Further defines relationship between standards and operating rules, and ROI
Submitted CAQH CORE HYPERLINK "http://www.caqh.org/Reform/CAQHCORECommentLetter090611.pdf" comment letter to CMS, e.g.
Include Acknowledgements to realize ROI, maintain broad scope of operating rules given ACA goals, and name CAQH CORE as single operating rule author given need for industry direction and resources
On September 22, 2011, NCVHS issued a HYPERLINK "http://ncvhs.hhs.gov/110922lt3.pdf" letter recommending Acknowledgements are formally recognized standards and that CORE operating rules for these standards also be recognized
CAQH CORE dialoguing with CMS eHealth Office regarding public comments as some of the comments relate to foundational aspects of CAQH CORE
Limiting the scope/definition of operating rules would limit the ability of operating rules to target administrative burden
Next Steps:
CAQH CORE will work with CMS to answer questions and adjust rules as appropriate
Once the final rule is issued, CAQH CORE will assist with the roll out and continue to support maintenance of the rules
Electronic Funds Transfer (EFT) & Electronic Remittance Advice Operating Rules Status (Progress to Date- November 2011)
In February 2011, NCVHS recommended NACHA (financial services operating rule entity) as a healthcare EFT Standards Development Organizaton and its Automated Clearing House CCD+ as a standard format (pharmacy to be addressed in CAQH CORE Operating Rules as appropriate)
In March 2011, NCVHS recommended CAQH CORE, in collaboration with NACHA, as author; pharmacy addressed in CAQH CORE Operating Rules as appropriate
CCD+ is a NACHA standard; data and dollars travel separately
Five draft rules developed by CAQH CORE process; federal agencies actively involved
In September, draft rules approved by CAQH CORE Rules Work Group
NCVHS updated on rules status in September
Next Steps:
Move Draft CAQH CORE EFT & ERA Operating Rules to final stage of CAQH CORE voting, taking Final HHS Rule on Federally mandated Eligibility and Claim Status regulation into consideration for potential adjustments; finalizing CORE Certification Test Suite for voluntary CORE Certification
Project potential impact of Draft CAQH CORE EFT & ERA Operating Rules and share with HHS
CMS will work with NCVHS to determine appropriateness of draft rules for potential Interim Final Rule; CAQH CORE to support as appropriate
Cross Industry Collaboration and Needs (November 2011)
CAQH CORE and NACHA: Healthcare and Financial Services alignment
Due to the mandated healthcare operating rules on EFT & ERA, there is a convergence of financial services and healthcare so partnership has pursued additional activities, e.g., extensive research on EFT & ERA opportunity areas
During the development of the Draft CAQH CORE EFT & ERA Operating Rules, the CAQH CORE participants identified key areas where either new or modified NACHA Operating Rules could address current issues in using the NACHA CCD+ when doing EFT healthcare payments over the ACH Network and draft rules convey these opportunities to NACHA
CAQH CORE and NCPDP: Medical and Pharmacy alignment
For each rule requirement, applicability to Retail Pharmacy was discussed and, for each rule, applicability of one of the following approaches determined:
Reference to a specific NCPDP pharmacy effort is included; include high-level on how CAQH CORE and NCPDP are coordinated to focus industry improvement in the shared area of interest addressed in the specific rule
Pharmacy is addressed in the operating rule directly (or via reference to NCPDP effort/document as noted above)
Pharmacy is excluded from the operating rule as it is not applicable and/or further research needs to be conducted
Official letter of communication from NCVHS on CORE initiatives to HHS: HYPERLINK "http://www.ncvhs.hhs.gov/111116lt2.pdf" http://www.ncvhs.hhs.gov/111116lt2.pdf
For More Information, visit HYPERLINK "http://www.caqh.org/ORMandate_EFT.php" http://www.caqh.org/ORMandate_EFT.php
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