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Current Initiatives of CORE Participants

CAQH CORE Participating Organizations help ensure that operating rules continue to meet evolving business needs, by engaging in the rule development process and maintenance of existing operating rules. Work groups are open to all CAQH CORE Participating Organizations, and multiple individuals from the same Participating Organization may join. Because each organization has only one vote, participants collaborate with their colleagues to submit an organizational-level response during voting periods

Below is a list of CAQH CORE work groups that currently convene or are upcoming as well as initiatives that are underway. In addition to contributing to these work groups and initiatives, as well as the formal CAQH CORE voting process, Participating Organizations benefit from exclusive education content and research opportunities.

Initiative Focus Current Objectives Co-Chairs Cadence
Initiative CORE Code Combinations Task Group

FocusRule Maintenance

 Current Objectives
  • Ensure compliance with the base standard code lists – CARCs and RARCs.
  • Conduct industry survey every two years to collect suggestions for potential market-driven adjustments to code combinations.
 Co-chairsLynn Franco,
UnitedHealth Group
Heather Morgan,
Aetna
Tyler Scheid,
AMA		 CadenceOnce every 2-3 months, for a total of 6 times a year
InitiativeEligibility and Benefit Task Group FocusRule Maintenance Current Objectives
  • The CORE Eligibility & Benefits Operating Rules establish consistent infrastructure and data content requirements. CORE published its initial version of the Eligibility & Benefits Data Content Rule in 2008 and has updated the rules over the years to align with the industry’s changing needs.
  • In collaboration with industry stakeholders including the National Council for Prescription Drug Programs (NCPDP) and the National Dental EDI Council (NDEDIC), the Task Group will update and enhance existing eligibility and benefit business processes. 
 Co-chairsDonna Campbell,
HCSC
Margaret Schuler,
Aspen Dental
Nikki Kerkhoff,
Trizetto Provider Solutions		 CadenceEvery 3 to 4 weeks from April to August
InitiativePilot & Measurements FocusROI; Opportunity
Identification		 Current Objectives
  • Attachments: Partner with stakeholders to measure the impact of the Attachment Operating Rules and corresponding standards on organization's efficiency metrics.
  • Quality Measure Reporting: Measure the impact of automating CPT II Codes within healthcare claims to convey non-service-related clinical information and meet quality measure reporting requirements.
 Co-chairsN/A  CadenceOngoing

If you would like to join any of the following initiatives, please contact core@caqh.org.