National Committee on Vital and Health Statistics (NCVHS) Recommends HHS Adopt CAQH CORE Operating Rules

CORE rules improve exchange of information related to prior authorization, telehealth, benefit coverage and value-based payment

WASHINGTON, July 12, 2023 /PRNewswire/ -- CAQH CORE today announced that the National Committee on Vital and Health Statistics (NCVHS) has recommended the adoption of CAQH CORE Operating Rules to the Secretary of Health and Human Services (HHS).

"Healthcare is constantly evolving, and timely, up-to-date guidelines are critical to driving automated data exchange," said Linda Reed, SVP and CIO St. Joseph's Health and CORE Board Chair. "By recommending these rules for adoption, NCVHS is helping to improve how payers and providers exchange information related to telehealth, prior authorization, benefit coverage, and value-based payment. Ultimately, patients will benefit from more informed and timely care delivery."

NCVHS recommended adoption of the following updated and new operating rules:

Updated Versions of Currently Mandated Operating Rules:

• CAQH CORE Connectivity Rule vC.4.0.0
• CAQH CORE Eligibility & Benefits (270/271) Data Content Rule vEB.2.0
• CAQH CORE Eligibility & Benefits (270/271) Infrastructure Rule vEB.2.0
• CAQH CORE Claim Status (276/277) Infrastructure Rule vCS.2.0
• CAQH CORE Payment & Remittance (835) Infrastructure Rule vPR.2.0

New Operating Rule:

• CAQH CORE Eligibility & Benefits (270/271) Single Patient Attribution Data Content Rule vEB.1.0

"CORE Operating Rules are created by and for healthcare stakeholders," said April Todd, Chief Policy and Research Officer at CAQH. "When the industry works together, we can streamline processes and improve the healthcare experience for everyone."

To read the NCVHS recommendations, click here.

To learn more about CAQH CORE Operating Rules and other ongoing initiatives, visit caqhcore.org.

About CAQH CORE
Industry-led, CAQH CORE was formed to drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers, and consumers. CAQH CORE Participating Organizations represent more than 75 percent of insured Americans, including plans, providers, vendors, government entities, and standard setting organizations. CAQH CORE Operating Rules and Certification Test Suites addressing eight healthcare business transactions have been issued to date. For more information, visit caqhcore.org.

SOURCE CAQH