CAQH CORE Announces Launch of 2014 Market-based Review for CORE Code Combinations

2014 Market-based Review of CORE Code Combinations The CAQH® Committee on Operating Rules for Information Exchange (CORE®) today launched the industry-wide submission period for the 2014 Market-based Review (MBR) of the CORE-required Code Combinations for the CORE-defined Business Scenarios.  Per the established CAQH CORE Code Combinations Maintenance Process, the CAQH CORE Code Combinations Task Group (CCTG) conducts two types of reviews and adjustments: Compliance-based Reviews and Market-based Reviews. Market-based Reviews occur once per year and enable the industry to make adjustments to the CORE Code Combinations to address ongoing and evolving business needs. The 2014 MBR will consider adjustments to the existing four CORE-defined Business Scenarios and the potential addition of new CORE-defined Business Scenarios, with associated code combinations. 2014 MBR INDUSTRY-WIDE SUBMISSION PERIOD To satisfy the CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rulegoal to support maintenance requirements and ensure that the MBR process addresses evolving industry business needs, the CCTG created the components of the online CAQH CORE 2014 Market-based Adjustments Form. The form will be used to collect the necessary input from the industry so thoughtful maintenance can occur.  Due Date: Responses to the 2014 MBR must be received by 5pm ET on Monday, 01/26/15. Who Can Submit: All CORE Participants, plus non-CORE Participants that create, use, or transmit HIPAA-covered transactions, may submit potential Market-based adjustments via the online CAQH CORE 2014 Market-based Adjustments Form.  Getting Started: Eligible entities wishing to participate in the 2014 MBR can begin by completing Part 1 of the online 2014 Market-based Adjustments Form HERE. ADDITIONAL RESOURCES Detailed instructions to assist in the completion of the online CAQH CORE 2014 Market-based Adjustments Form are available HERE. A sample completed CAQH CORE 2014 Market-based Adjustments Form is also available HERE for consultation as entities plan their submission. Additionally, CAQH CORE education sessions will be offered explaining the MBR submission process. If you need additional assistance in navigating the Market-based Adjustments Form or have any questions regarding the 2014 MBR, please email core@caqh.org.

2014 Market-based Review of CORE Code Combinations will Launch November 26, 2014

Advance Notice: 2014 Market-based Review of CORE Code Combinations On November 26, 2014, the CAQH® Committee on Operating Rules for Information Exchange (CORE®) will launch the 2014 Market-based Review (MBR) of theCORE-required Code Combinations for the CORE-defined Business Scenarios. Per the established CAQH CORE Code Combinations Maintenance Process, the CAQH CORE Code Combinations Task Group (CCTG) conducts two types of reviews and adjustments:  Compliance-based Reviews occur three times per year and only consider updates to the published CARC and RARC lists since the last version of theCORE Code Combinations. Market-based Reviews occur once per year and enable the industry to make adjustments to the CORE Code Combinations to address ongoing and evolving business needs. SCOPE OF THE 2014 MBR The 2014 MBR will consider adjustments to the existing four CORE-defined Business Scenarios and the potential addition of new CORE-defined Business Scenarios. Potential industry submissions include:  Code additions, removals, and relocations to code combinations in theexisting CORE-defined Business Scenarios. Requests for potential new CORE-defined Business Scenarios. Code combinations for association with the requested new CORE-defined Business Scenarios. INDUSTRY-WIDE 2014 MBR SUBMISSION PERIOD To satisfy the CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rulegoal to support maintenance requirements and ensure that the MBR process addresses evolving industry business needs, the CCTG created the components of the online 2014 MBR Submission Form. The form will be used to collect the necessary input from the industry so thoughtful maintenance can occur.  Submission Period:  The 2014 MBR Submission Form will open on Wednesday, 11/26/14. Responses to the Market-based Review must be received by 5pm ET onMonday, 01/26/15. Who Can Submit:  The Submission Period is open to all applicable industry entities. All CORE Participants, plus non-CORE Participants that create, use, or transmit HIPAA-covered transactions, may submit potential Market-based adjustments via the online 2014 MBR Submission Form. A link to the online submission form will be provided in the formal launch announcement, along with detailed instructions to assist respondents in completing the form. Additionally, CAQH CORE will announce education sessions that will explain the MBR submission process. Please do not hesitate to contact core@caqh.org with any additional questions.

CAQH CORE National Webinar - Nov. 19, 2014 - Open Mic Session with CAQH CORE

CAQH CORE National Webinar  CAQH CORE Open Mic Session -  Now is the Chance to Get All of Your Questions Answered November 19, 2014 2:00 PM - 3:00 PM ET REGISTER There is no fee to attend  YOU asked, WE listened Welcome to the CAQH CORE Open Mic webinar Is your organization receiving all the advantages of CAQH CORE Operating Rules? Are you ready for the HHS final Rule on Health Plan Certification? Do you have questions about the Third Set of ACA-mandated Operating Rules? Please join us for this special 'Open Mic' session to get your questions answered by CAQH CORE experts. Based on your feedback, this session is designed as an open forum - one full hour - to enable you to ask your questions about the following topics: Voluntary CORE Certification CAQH CORE actions in response to the HHS NPRM on Health Plan Certification Rule development for the Third Set of ACA-mandated CAQH CORE Operating Rules CAQH CORE EFT & ERA Operating Rules and maintenance You will be able to ask questions via web and phone during this event. We encourage you to submit your questions when you register. Who Should Attend All HIPAA-covered entities that are currently in compliance with the EFT & ERA operating rules and those that want to ensure they are fully benefiting from the CARCs and RARCs Rule Note: A working knowledge of Federally Mandated CAQH CORE EFT & ERA Operating Rules is assumed. Register Now to Reserve Your Spot for This Free Education Session About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

CAQH CORE National Webinar - Nov. 13, 2014 - Transforming Financial Transactions through CAQH CORE Operating Rules

CAQH CORE NATIONAL WEBINAR FEATURING HCA AND CNSI Transforming Financial Transactions through CAQH CORE Operating Rules: A Medicaid Perspective November 13, 2014 2:00 PM - 3:00 PM ET REGISTER There is no fee to attend. A Medicaid Success Story about Financial Gains  through CAQH CORE Operating Rules Join us for this special webinar with the Washington Healthcare Authority (HCA)and its partner, CNSI, to find out how the CAQH CORE Operating Rules are transforming healthcare financial transactions, with a focus on the significance of Medicaid involvement. HCA and CNSI will share their CAQH CORE Operating Rules implementation strategy, lessons learned and best practices in configuring their MMIS to ensure operational compliance. In this session  Learn about HCA's implementation strategy for Phase I, II and III CAQH CORE Operating Rules Receive information about timelines and successful resolution of challenges during implementation Benefit from HCA's implementation learnings and how they achieved maximum value from Operating Rules implementation Get valuable insight into the significant gains achieved through Operating Rule implementation through early operational metrics shared by HCA and CNSI Participate in Q&A with representatives of HCA, CNSI and CAQH CORE Who Should Attend This session will be especially beneficial to State Medicaid Agencies to understand how they can benefit from the CAQH CORE Operating Rules, but the key lessons, benefits and best practices discussed during this webinar extend to other health plans, providers, clearinghouses and vendors that should currently be in compliance with the CAQH CORE Operating Rules. Note: A working knowledge of Federally Mandated CAQH CORE Operating Rulesis assumed. Register Now to Reserve Your Spot for This Free Education Session About HCA The Washington State Health Care Authority oversees the state's two top health care purchasers - Washington Medicaid called Washington Apple Health and the Public Employees Benefits Board (PEBB) Program that provides insurance coverage for eligible employees of state agencies, higher education institutions, certain employer groups and their families. About CNSI CNSI (www.cns-inc.com) is an industry leader in developing, implementing and operating cutting-edge technological solutions that modernize healthcare administration systems. At CNSI we revolutionize the way we manage healthcare through technological innovations which include mobile applications that provide easy access to health benefits, cloud based systems that provide for more efficient processing of medical claims and cutting edge technology that can eradicate improper billing and waste leading to better care, better health and lower costs. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.