October and NEW November Education Events by CAQH CORE

CAQH CORE October and NEW November  Education Events CAQH CORE October Town Hall National Webinar Thursday, October 22, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Join us for our quarterly Town Hall Call, a 60-minute interactive session, for the latest information on CAQH CORE activities, including:   The New Phase IV CAQH CORE Operating Rules: What's Next? Just approved by CORE vote! Get the first update on the new operating rules for claims, enrollment/disenrollment in a health plan, premium payments and prior authorizations, potential HHS action on Phase IV and soon to-be-released CORE FAQs, Planning and Analysis Guide and other implementation tools to help your Phase IV implementation go smoothly.    ACA-Mandated Health Plan Certification and Voluntary CORE Certification Update: With the statutory compliance date looming ahead, learn about the ACA-mandated health plan certification and, as we surpass the 200 CORE Certifications milestone, hear about current trends and why voluntary CORE Certification continues to grow in popularity.   Ongoing Maintenance of EFT/ERA - Get Involved! CORE is responsible for ongoing updates to the mandated Operating Rules: the EFT/ERA enrollment data set and the CAQH CORE Code Combination Maintenance Processes and Market-based Review. Your organization should get engaged in these efforts and have direct input into these revisions. Use the Code Combinations NOW to improve your claim adjustments and denials, and ensure they reflect industry usage and YOUR business needs. Hear how you can join these efforts, and how to report out your results.   CORE Future Focus: What are the opportunities being discussed by the CAQH CORE Board? Hear how they are considering where CORE can add the most value as the market moves from fee-for-service to value-based purchasing, and as we learn best practices from implementing some of the initial sets of ACA-driven operating rules.    Best practices in action! Mark your calendars for upcoming CAQH CORE webinar topics, including sessions on multi-phase CORE Certification, and how to improve your payment-remittance transactions.   Q&A: Bring your questions and share information about your experiences and benefits from your use of CORE Operating Rules, the CARC & RARC Code Combinations, and /or the CORE Certification process.   CAQH CORE Town Hall Calls provide the public with an update on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. _____________________________________________________________ Triple Play: Pursuing Voluntary CORE Certification Phases I through III Simultaneously Featuring: Group Health Cooperative Tuesday, October 27, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Register for this webinar to learn about voluntary CORE Certification, one of the documents of compliance in the proposed rule for the ACA-mandated HHS health plan certification. Get an insider look at the experience of a recent CORE-certified entity, Group Health Cooperative, a member-governed, nonprofit health care system that coordinates care and coverage for more than 600,000 residents of Washington and North Idaho.Group Health Cooperative chose to pursue Phase I, II, & III CORE Certification concurrently, and they will discuss their approach to, and the benefits and challenges of, pursuing CORE Certification for all three phases at the same time. Get helpful advice from CAQH CORE-authorized Testing Vendor EDIFECS who will share tips to ensure the CORE Certification testing process goes smoothly, whether you work on one or multiple certifications. _____________________________________________________________ Implementing the EFT/ERA Operating Rules: Implementation Experience from the Nation's Largest Integrated Healthcare System - the U.S. Department of Veteran's Affairs Featuring: U.S. Department of Veteran's Affairs Thursday, November 5, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Hear the operating rule implementation experience of the country's largest integrated healthcare system- the U.S. Department of Veteran's Affairs - focused on their experience, from a provider perspective, with the Phase III operating rules. In 2014, the VA sent and received over 65 million healthcare transactions. Learn from an implementer how you can benefit from the EFT/ERA operating rules in terms of standardization, efficiency, reduced errors and savings. _____________________________________________________________   Joint National Webinar with CAQH CORE, ASC X12 and NACHA: Matching Payments to Services Delivered - What Every Provider and Health Plan Should Expect, and What Every Trading Partner  Should Deliver     Tuesday, November 10, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Many stakeholders do not realize how easy it now is to use the NACHA CCD+ specification, the ASC X12 v5010 835, and the CAQH CORE Reassociation Rule. Used together, they are the driving force behind getting full value from these interconnected payment-remittance transactions. You will hear from these three organizations specific positive impacts that can occur on both the provider's revenue cycle management and health plan resources when automated re-association occurs.    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.

October Education Events by CAQH CORE

CAQH CORE October Education Events CAQH CORE October Town Hall National Webinar Thursday, October 22, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Join us for our quarterly Town Hall Call, a 60-minute interactive session, for the latest information on CAQH CORE activities, including:   The New Phase IV CAQH CORE Operating Rules: What's Next? Just approved by CORE vote! Get the first update on the new operating rules for claims, enrollment/disenrollment in a health plan, premium payments and prior authorizations, potential HHS action on Phase IV and soon to-be-released CORE FAQs, Planning and Analysis Guide and other implementation tools to help your Phase IV implementation go smoothly.    ACA-Mandated Health Plan Certification and Voluntary CORE Certification Update: With the statutory compliance date looming ahead, learn about the ACA-mandated health plan certification and, as we surpass the 200 CORE Certifications milestone, hear about current trends and why voluntary CORE Certification continues to grow in popularity.   Ongoing Maintenance of EFT/ERA - Get Involved! CORE is responsible for ongoing updates to the mandated Operating Rules: the EFT/ERA enrollment data set and the CAQH CORE Code Combination Maintenance Processes and Market-based Review. Your organization should get engaged in these efforts and have direct input into these revisions. Use the Code Combinations NOW to improve your claim adjustments and denials, and ensure they reflect industry usage and YOUR business needs. Hear how you can join these efforts, and how to report out your results.   CORE Future Focus: What are the opportunities being discussed by the CAQH CORE Board? Hear how they are considering where CORE can add the most value as the market moves from fee-for-service to value-based purchasing, and as we learn best practices from implementing some of the initial sets of ACA-driven operating rules.    Best practices in action! Mark your calendars for upcoming CAQH CORE webinar topics, including sessions on multi-phase CORE Certification, and how to improve your payment-remittance transactions.   Q&A: Bring your questions and share information about your experiences and benefits from your use of CORE Operating Rules, the CARC & RARC Code Combinations, and /or the CORE Certification process.   CAQH CORE Town Hall Calls provide the public with an update on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. _____________________________________________________________ Triple Play: Pursuing Voluntary CORE Certification Phases I through III Simultaneously Featuring: Group Health Cooperative Tuesday, October 27, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Register for this webinar to learn about voluntary CORE Certification, one of the documents of compliance in the proposed rule for the ACA-mandated HHS health plan certification. Get an insider look at the experience of a recent CORE-certified entity, Group Health Cooperative, a member-governed, nonprofit health care system that coordinates care and coverage for more than 600,000 residents of Washington and North Idaho.Group Health Cooperative chose to pursue Phase I, II, & III CORE Certification concurrently, and they will discuss their approach to, and the benefits and challenges of, pursuing CORE Certification for all three phases at the same time. Get helpful advice from CAQH CORE-authorized Testing Vendor EDIFECS who will share tips to ensure the CORE Certification testing process goes smoothly, whether you work on one or multiple certifications.   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 Announces New National Healthcare Operating Rules

October 2015

CAQH CORE Announces New  National Healthcare Operating Rules Health plans, healthcare providers, and the clearinghouses and vendors that support them, now have national operating rules to improve how they can work together as trading partners. The voluntary operating rules will help streamline the electronic data exchange of four more healthcare business transactions: healthcare claims; prior authorization; employee premium payment; and enrollment and disenrollment in a health plan. CAQH CORE recently announced that the Phase IV CAQH CORE Operating Rules package has been approved and the industry should begin coordinating voluntary implementation. Reaching this milestone is the result of enormous effort by the multi-stakeholder CAQH CORE collaboration, which includes a wide range of public and private entities. Continue reading...

Other News

CAQH CORE Town Hall National Webinar October 22, 2015 | 2:00 PM ET Learn about important industry updates and how they will affect organizations. CAQH CORE Town Hall Calls provide the public with an update on recent CORE activities related to industry development and/or implementation of Federally mandated operating rules. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur.    Register or Learn More

Voluntary CAQH CORE Certification National Webinar with Group Health Cooperative October 27, 2015 | 2:00 PM ET Register for this webinar to learn about CORE Certification and whether it is appropriate for your type of organization. And get an insider look at the experience of a recent CORE-certified entity, Group Health Cooperative, a member-governed, nonprofit health care system that coordinates care and coverage for more than 600,000 residents of Washington and North Idaho. Register or Learn More

CAQH In the News Four Updated HIPAA Transactions Coming by Mid-2016 New Rules for Electronic HIPAA Transactions Approved by CAQH CORE  Employers, Employee Benefit Managers and Health Plans will be Impacted by New National Operating Rules for HIPAA Transactions New Operating Rules Approved for HIPAA Health Data Exchange New National Healthcare Operating Rules Approved for Electronic HIPAA Transactions CAQH: New National Healthcare Operating Rules Approved for Electronic HIPAA Transactions Voluntary Operating Rules Approved for Insurance Transactions New national healthcare operating rules approved for electronic HIPAA transactions Atlantic Information Services, CAQH to Present Complimentary Webinar on Streamlining Healthcare Benefits Coordination Availity earns CAQH CORE Clearinghouse Product Phase III Certification Seal Debunking Myths about Healthcare EFT

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October Education Events by CAQH CORE

CAQH CORE October Education Events CAQH CORE October Town Hall National Webinar Thursday, October 22, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Join us for our quarterly Town Hall Call, a 60-minute interactive session, for the latest information on CAQH CORE activities, including:   The New Phase IV CAQH CORE Operating Rules: What's Next? Just approved by CORE vote! Get the first update on the new operating rules for claims, enrollment/disenrollment in a health plan, premium payments and prior authorizations, potential HHS action on Phase IV and soon to-be-released CORE FAQs, Planning and Analysis Guide and other implementation tools to help your Phase IV implementation go smoothly.    ACA-Mandated Health Plan Certification and Voluntary CORE Certification Update: With the statutory compliance date looming ahead, learn about the ACA-mandated health plan certification and, as we surpass the 200 CORE Certifications milestone, hear about current trends and why voluntary CORE Certification continues to grow in popularity.   Ongoing Maintenance of EFT/ERA - Get Involved! CORE is responsible for ongoing updates to the mandated Operating Rules: the EFT/ERA enrollment data set and the CAQH CORE Code Combination Maintenance Processes and Market-based Review. Your organization should get engaged in these efforts and have direct input into these revisions. Use the Code Combinations NOW to improve your claim adjustments and denials, and ensure they reflect industry usage and YOUR business needs. Hear how you can join these efforts, and how to report out your results.   CORE Future Focus: What are the opportunities being discussed by the CAQH CORE Board? Hear how they are considering where CORE can add the most value as the market moves from fee-for-service to value-based purchasing, and as we learn best practices from implementing some of the initial sets of ACA-driven operating rules.    Best practices in action! Mark your calendars for upcoming CAQH CORE webinar topics, including sessions on multi-phase CORE Certification, and how to improve your payment-remittance transactions.   Q&A: Bring your questions and share information about your experiences and benefits from your use of CORE Operating Rules, the CARC & RARC Code Combinations, and /or the CORE Certification process.   CAQH CORE Town Hall Calls provide the public with an update on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. _____________________________________________________________ Triple Play: Pursuing Voluntary CORE Certification Phases I through III Simultaneously Featuring: Group Health Cooperative Tuesday, October 27, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Register for this webinar to learn about voluntary CORE Certification, one of the documents of compliance in the proposed rule for the ACA-mandated HHS health plan certification. Get an insider look at the experience of a recent CORE-certified entity, Group Health Cooperative, a member-governed, nonprofit health care system that coordinates care and coverage for more than 600,000 residents of Washington and North Idaho.Group Health Cooperative chose to pursue Phase I, II, & III CORE Certification concurrently, and they will discuss their approach to, and the benefits and challenges of, pursuing CORE Certification for all three phases at the same time. Get helpful advice from CAQH CORE-authorized Testing Vendor EDIFECS who will share tips to ensure the CORE Certification testing process goes smoothly, whether you work on one or multiple certifications.   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.

Updated Version of CORE Code Combinations Available for Implementation

Updated Version Now Available: October 2015 CORE Code Combinations v3.2.1 - Includes Adjustments for the Latest Compliance-based Review  The October 2015 updated version of the CORE-required Code Combinations for the CORE-defined Business Scenarios (CORE Code Combinations) is now available for use with the CAQH CORE 360: Uniform Use of CARCs and RARCs Rule. This version includes Compliance-based Adjustments as a result of code list updates published on July 1, 2015.   The CAQH CORE 360 Rule enables more uniform use of the Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) by focusing on a minimum set of common or problematic Business Scenarios, along with a maximum specified set of code combinations for each of these Scenarios. Per CAQH CORE policy, the CORE Code Combinations must be updated by the CAQH CORE Code Combinations Task Group to both: Align with the current published CARC and RARC lists which are maintained by code committees and updated at least three times per year. (Compliance-based Reviews); and Address ongoing and evolving industry business needs on an annual basis. (Market-based Reviews). A marked-up version of the October 2015 CORE Code Combinations showing the adjustments between v.3.2.0 and v.3.2.1 is available HERE. The Change Log in the second tab of the CORE Code Combinations provides a list of all adjustments made to the CORE Code Combinations.    For more information visit the Ongoing Maintenance of the CORE Code Combinations for CAQH CORE 360 Rule Webpage, a "one stop shop" for all the tools and information you need to comply with the CAQH CORE 360 Rule and the ongoing code combinations maintenance process. This website page includes both update summaries and links to more details.   In Q4 2015, the CAQH CORE Code Combinations Task Group will launch its next Compliance-based Review to review updates from the code list authors that are scheduled for publication in November 2015. The Task Group will also launch its Market-based Review of the potential new CORE-defined Business Scenarios submitted via the Industry-wide CAQH CORE 2014 Market-based Adjustments Form.   CAQH CORE Participants are encouraged to get involved with the Task Group. Contact core@caqh.org for information on joining the Task Group or becoming a CAQH CORE Participating Organization.   Please contact core@caqh.org with any additional questions.