Healthx president Greg Bell reports that his company has seen a big increase in the number of healthcare payers looking for CAQH CORE II solutions during the first months of 2013.
Bell surmises that the inquiries are the results of panic in the face of upcoming non-compliance penalties.
Within nine months, healthcare payers like insurance companies and third-party plan sponsors, such as employers and unions, must demonstrate CAQH CORE II compliance or face hefty penalties from the U.S. Department of Health and Human Services.
CORE requirements are designed to enhance interoperability between providers and payers; to streamline eligibility, benefits and claim data transactions; and to reduce the amount of time that providers spend on administrative functions, allowing them more time to focus on patient care.
CAQH is a major industry alliance consisting of health insurance and trade associations, designed to simplify healthcare administration. CORE I implementation, according to the group, had many positive effects.
For example, electronic insurance eligibility checks took seven minutes less than telephone verifications, and saved providers $2.60 per verification.
CAQH estimates that there were over one billion verification requests in 2012 alone.
CORE I focused on verifying patient benefit coverage, co-pay, coinsurance and base deductible information over a real-time Internet connection. Phase II includes providing information on patient accumulators, improving patient matching, infrastructure requirements (such as response time) and stricter connectivity requirements with submitter authentication.
Additionally, providers who collaborated with CORE-certified payers cut claim denials by 10 to 12 percent. They also saw a 24-percent increase in the number of patients identified before a visit.
Investments in technology to become CORE compliant are recouped within 12 months, CAQH says. A switch from telephone to electronic claim verification can save providers up to $2.5 million per plan in administrative costs.
Despite the advantages, many payers have waited until the last minute to start implementing a CORE II solution. For the rest of the year, Healthx expects the number of inquiries regarding its offerings to continue to increase.
Edited by
Braden Becker
