Edifecs5010™ & CORE

CAQH launched CORE to create a national all-payer solution that enables provider access to patient insurance information before or at the time of service using the electronic system of their choice. The organization has brought together more than 100 industry stakeholders to collaborate on a multi-phase set of uniform business rules to achieve that goal.

The CORE Phase II rules expand upon the data consistency and interoperability improvements gained by rules created in CORE Phase I. The Phase II rules cover requirements for electronic connectivity, patient identifiers, claims status and reporting of year-to-date patient financial responsibility and coverage, including an increased number of service type codes that are defined by HIPPA.

In anticipation of the industry moving from HIPAA Version 4010 to Version 5010, CORE Phase I and Phase II rules incorporate many of the features found in the X12 5010 TR3s to address the common information needs for patient eligibility.

Using a set of objective, standards-based test scripts designed by CORE participants, Edifecs will test to certify that any interested health plan, health information technology vendor or large provider group can exchange data according to the CORE Phase II rules.

Click here for Edifecs CORE testing & certification.

Click here to visit CAQH/CORE website.