CORE Overview:

ACA Changes: EDI CAQH/CORE Phases I, II & III

The Committee on Operating Rules for Information Exchange (CORE) physicians and hospitals access to patient eligibility and benefit info in real-time before or during their medical needs.

The Committee on Operating Rules for Information Exchange (CORE) was launched by CAQH.  CORE gives physicians and hospitals access to patient eligibility and benefit information in real-time before or during their medical needs.

CORE CAQH Rule 270/271 and 276/277 requires Servers to provide connectivity information while sharing Eligibility & Benefits and Claims information via and EDI transaction.

CORE Benefits:

Interoperability between payers and providers

  • Real-time or batch access to eligibility, benefits and claim data
  • Administrative simplification

 

CORE Operating Rules

Affordable Care Act (ACA) defines operating rules as “the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications.”

 

CORE Operating Rules Phase I & Phase I

Connectivity requirements

  • SOAP and MIME
  • Eligibility and claim status consists of 270/271 and 276/277 ANSII X12 Transactions
  • Real-time and batch processing
  • Testing

​CORE Operating Rules Phase III

  • 835 ANSII X12 Transaction

 

Let IMI’s proven track record in healthcare guide you with a successful implementation of the ACA mandate.  Most recently, IMI has successfully implemented CORE Operating Rules Phase I & II for the County of Santa Barbara, CA.  Make sure your organization is ready for the ACA mandate as it goes in effect January 1st 2014.  To learn more about how IMI can help prepare your organization, contact us at 847.987.3810.

For mor information about core, please visit: http://www.caqh.org