Edifecs, CAQH CORE and Harvard Pilgrim Health Care Will Examine CORE Phase II Testing Outcomes and Lessons Learned At HIMSS09 Interoperability Showcase
Harvard Pilgrim Health Plan achieves CORE Phase II Testing Certification with Edifecs CORE Certification Testing Service - includes compliance with rules that are now required in X12 Version 5010.
Bellevue, WA (March 31st, 2009). Edifecs announced today that it will, together with its partners CAQH CORE and Harvard Pilgrim Healthcare examine the outcomes and lessons learned from the CORE Phase II Certification testing including elements of the newly mandated 5010 Rules, in a presentation at the HIMSS09 Interoperability Showcase, on Tuesday, April 7, 11:15 AM - 11:45 AM (CT).
The HIMSS09 Interoperability Showcase has become an internationally recognized forum for highlighting the Integrating the Healthcare Enterprise's (IHE) common framework for delivering interoperability across local, regional, and national health information exchanges. It features advanced technology and standards in an interactive environment using test scenarios that simulate how health information is seamlessly passed across the full continuum of care.
Throughout the conference, CAQH CORE and Edifecs will be available at Booth #7750, McCormick Place, North Hall to demonstrate the Edifecs Online CORE Certification Testing Service and Harvard Pilgrim Health Care will be conducting live transmissions of CORE Phase II Certified Eligibility & Benefits Inquiry and Response 270/271 transactions that incorporate 5010 standard processing rules.
"This collaborative demonstration will showcase how Harvard Pilgrim Health Care is already taking advantage of the benefits of the improved operating rules defined in the newly mandated 5010 standards. As an early adopter of the CORE Phase II rules, HPHC is producing real-world results that will have a long-term, positive impact on healthcare administration," said Ginger Wright, Senior Practice Manager at Edifecs. She continued, "In our presentation on Tuesday we will explain the synergies between achieving CORE Phase II certification testing now and ongoing 5010 guideline migration efforts".
Initiated by CAQH, CORE supports a nationwide drive to provide patient information electronically, ideally before services are performed, or at time of service. Improving provider access to administrative and payer-specific information is one of the underlying goals of CORE, as well as creating interoperability among parties based on technical platforms that are both vendor and technology neutral. Therefore participants are able to exchange data with any technology and applications they select.
Entities must complete a testing process leveraging Edifecs CORE Phase I and or CORE Phase II Certification testing online with Edifecs5010 CORE Testing and Certification Services. This service confirms that an organization's batch and/or online real-time systems and applications comply with the CORE Phase I and Phase II rules. Phase I certification is required prior to completing Phase II certification. The CORE rules now allow for entities to complete Phase I and II certification testing during a single, integrated process.
Built and maintained by Edifecs, the CORE Certification testing online service validates compliance with CORE rules as defined by CORE members, using testing scripts and test data developed by the CORE Work Group consisting of providers, payers, clearinghouses, government payers and other healthcare stakeholders. CORE's Phase I and II rules encompass many of the 5010 requirements and support existing IHE and HITSP work already being used in the marketplace. Edifecs and HPHC will address issues of great potential for the Payer and Provider communities operating with the CORE Phase I and Phase II Rules, including the return of patient financial information that has been included in CORE requirements - using the HIPAA standards since April 2006, well ahead of the requirements in 5010. The CORE requirements specify return co-pay, co-insurance, and static deductible and 5010 recommendations to return "In Network" and "Out of Network" variances and YTD remaining deductibles.
"This review is a good example of how HIPAA 5010 standards are already working well in the workplace. By using CORE's rigorous testing we can readily prepare for the new 5010 initiative" said John Kelly, Senior IT Consultant, Office of the CIO, Harvard Pilgrim Health Care.
About Edifecs, Inc.
Edifecs helps organizations achieve interoperability and return on investment by simplifying the adoption of standard electronic transactions and deriving business value from trading partner communities. 2008 marks 12 years of Edifecs' expertise in providing innovative technology solutions to over 1000 clients worldwide. Founded in 1996, Edifecs is headquartered in Bellevue, WA. Contact: Kevin Pierce, 425-452-0622.
About Harvard Pilgrim Health Care
Harvard Pilgrim Health Care is a not-for-profit health plan that provides a variety of insurance plan options and self-funding arrangements to more than one million members in Massachusetts, New Hampshire and Maine. Harvard Pilgrim provides innovative approaches to health improvement and disease management, unique online tools that speed and simplify key transactions for employers and providers and personalized health support at www.harvardpilgrim.org.
About CAQH
CAQH, a nonprofit alliance of health plans and trade associations, is a catalyst for healthcare industry collaboration on initiatives that streamline healthcare administration, resulting in a better care experience for patients and caregivers. CAQH solutions - like CORE - help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration and encourage administrative-clinical data integration. More than 100 healthcare industry stakeholders are collaborating on CORE.
Participating health plans cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries. Over 35 health plans, large provider groups and health IT products are Phase I CORE-certified and committed to Phase II certification. Visit www.caqh.org for more information.
About HIMSS
The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore and other locations across the United States and Europe, HIMSS represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care. Visit www.himss.org for more information.
CORE Certification
Edifecs has been selected as an approved CORE testing vendor by CAQH. The Edifecs CORE testing service will allow entities interested in becoming certified by CAQH to perform the requirements necessary to show compliance with all of the CORE Rules. CORE Phase I and Phase II Certification are available for providers, health plans, clearinghouses and vendors. For more information, visit CAQHs CORE website at http://www.caqh.org/benefits.php.
