Emdeon Achieves CAQH CORE Phase III Certification

Furthers Emdeon's leadership position in healthcare efficiency and demonstrates commitment to streamlining healthcare payments

Jan 13, 2014, 08:30 ET from Emdeon Inc.

NASHVILLE, Tenn., Jan. 13, 2014 /PRNewswire/ -- Emdeon Inc., a leading provider of healthcare revenue and payment cycle management and clinical information exchange solutions, today announced it has achieved CAQH® Committee on Operating Rules for Information Exchange (CORE®) Phase III Certification. The CORE Seal was awarded after Emdeon successfully completed voluntary CORE Certification testing, ensuring it can exchange Healthcare Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) information in conformance with the Phase III CAQH CORE EFT & ERA Operating Rules and Policies.

The CAQH CORE EFT & ERA Operating Rules help enable accurate and efficient payment and claims processing, which saves time and money for organizations using the rules. The operating rules make it easier for healthcare providers to enroll in and benefit from these transactions by requiring standardized healthcare provider enrollment in EFT and ERA and easing the reassociation of EFTs and ERAs. 

As the largest clinical, financial and administrative health information network in the nation, Emdeon processed nearly seven billion health information exchanges in 2012. Emdeon has provided technology solutions for more than 30 years that help manage the flow of information between healthcare payers and providers and bridge the gaps caused by disparate rules for data exchange.

"Our CAQH CORE Phase III certification demonstrates our continued commitment to assure Emdeon products and services meet Department of Health and Human Services Regulatory Standards and Operating Rules," said Damien Creavin, chief information officer for Emdeon. "In achieving CORE Phase III compliance, Emdeon is not only amongst the first to do so but furthers its position as an industry leader committed to healthcare efficiency and broadens its capabilities to transact information in accordance with industry standards."

Together, the Phase I, II and III CAQH CORE Operating Rules, most of which have been adopted under federal law implementing the Patient Protection and Affordable Care Act (ACA), are estimated to save as much as $15 billion over 10 years. According to the Centers for Medicare & Medicaid Services, the net savings derived from using the EFT & ERA Operating Rule Set over 10 years ranges from approximately $300 million to $3.3 billion.

"The Phase III CAQH CORE Operating Rules help streamline electronic payments processes," said Gwendolyn Lohse, deputy director of CAQH and managing director of CAQH CORE. "By completing Phase III CORE Certification, Emdeon is publicly demonstrating commitment to operate in accordance with the operating rules and simplify healthcare administration."

CAQH CORE is a multi-stakeholder industry collaboration of more than 140 stakeholders developing and adopting national operating rules that streamline administrative transactions. CORE participating organizations collectively cover more than 150 million lives or approximately 75 percent of the commercially insured, plus Medicare and Medicaid beneficiaries.

In its role as the HHS-recognized author for federally mandated administrative simplification operating rules under the ACA, CAQH CORE is focused on two priority areas in 2014. CORE participants will work to ensure market implementation of the existing rules and also develop the remaining ACA-mandated operating rules, including healthcare claims or equivalent encounter information, enrollment/disenrollment in a health plan, health plan premium payments, referral certification and authorization, and claim attachments.

About Emdeon

Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers and patients in the U.S. healthcare system. Emdeon's offerings integrate and automate key business and administrative functions of its payer and provider customers throughout the patient encounter. Through the use of Emdeon's comprehensive suite of solutions, which are designed to easily integrate with existing technology infrastructures, customers are able to improve efficiency, reduce costs, increase cash flow and more efficiently manage the complex revenue and payment cycle and clinical information exchange processes. For more information, visit www.emdeon.com.


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.


SOURCE Emdeon Inc.