CAQH CORE Vision: An industry-wide facilitator of a trusted, simple and sustainable healthcare data exchange that evolves and aligns with market needs.
CAQH CORE Mission: Drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers and consumers.
CAQH CORE is an industry-wide stakeholder collaboration committed to the development and adoption of national operating rules for administrative transactions. The more than 140 CORE Participants represent all key stakeholders including providers, health plans, vendors, clearinghouses, government agencies, Medicaid agencies, banks and standard development organizations.
- Enhance interoperability between providers and payers
- Streamline eligibility, benefits, and claim data transactions
- Reduce the amount of time and resources providers spend on administrative functions – time better spent with patients.
CORE is tracking and has published metrics regarding rule impact to help quantify participant return on investment.
Operating rules build on existing standards to make electronic transactions more predictable and consistent, regardless of the technology. Rights and responsibilities of all parties, security, transmission standards and formats, response time standards, liabilities, exception processing, error resolution and more must be clearly defined in order to facilitate successful interoperability. Beyond reducing cost and administrative hassles, operating rules foster trust among all participants.