Term: Committee on Operating Rules for Information Exchange (CORE)

Description: Committee on Operating Rules for Information Exchange (CORE) is a CAQH launched initiative that has a main goal of cutting down time to find important patient information which in turn cuts down on administrative costs and also promotes standardization among healthcare providers. CORE wants to provide updated information on eligibility and benefits of patients in a fast and reliable method. CORE is made up of more than 80 industry stakeholders made up of a variety of sectors in the healthcare field. These stakeholders work in collaboration to build a consensus of rules that will “enhance interoperability between providers and payers, streamline eligibility and benefits data transactions, and reduce the amount of time and resources providers spend on administrative functions – time better spent with patients[[#_ftn1|[1]]]”. With these cuts in time CAQH has established that CORE organizations can cut up to 50 pecent in labor cost by switching to the less labor intensve method.

CORE expects to standardize the collaborative rules in three phases. Phase I asked for the pledge to sign and agree to the set of rules CORE has set forth in order to have a standard among all of the CORE agencies. Phase II builds upon the rules set forth in Phase I while adding additional rules that deal in the areas of patient identifiers, patient accumulators, claims status and connectivity.[[#_ftn2|[2]]]

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Related Terminology:

Phase II Polices and Rules

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