CORE (which stands for Committee on Operating Rules for Information Exchange ) is an initiative facilitated by the Council for Affordable Quality Healthcare (CAQH). The ultimate goal of CORE is to decrease the amount of time and resources providers spend verifying patient eligibility, benefits, claim status and other administrative information at the point of care.
What CORE means for employers is that incorrectly denied claims and delayed paperwork may be a thing of the past, by developing systems that:
- Enable providers to submit transactions from the system of their choice (vendor agnostic) and quickly receive a standardized response from any participating stakeholder
- Enable stakeholders to implement CORE phases as their systems allow
- Facilitate stakeholder commitment to, and compliance with, CORE’s long-term vision
- Facilitate administrative and clinical data integration
Harvard Pilgrim is the nation’s first health care plan certified in both the Phase I and Phase II rules of the CORE initiative in support of improving ease of doing business with our business partners.
The Phase I goal was to create, disseminate and maintain operating rules that enable healthcare providers to quickly and securely obtain reliable health plan eligibility and benefits information. CORE Phase II extends this capability to include operating rules around the claim status transaction to enable providers to check the status of a claim electronically, or confirm claims receipt, without manual intervention. CORE operating rules will decrease the amount of time and resources providers spend verifying patient eligibility, benefits, claim status and other administrative information at the point of care.
Through the CORE initiative, Harvard Pilgrim is working with everyone—health plans, professional societies, providers, vendors, associations, standard-setting organizations, government agencies and other health care-related constituencies—to make health care work better.