BCBST achieves certification for implementation of CAQH CORE Phase II rules

CAQH® announced today that BlueCross BlueShield of Tennessee (BCBST) has achieved certification for its implementation of the CAQH Committee on Operating Rules for Information Exchange® (CORE®) Phase II rules. The certification will benefit more than 3 million insured members of the Tennessee health plan.

BCBST is the latest healthcare organization to be awarded a Phase II Seal for its voluntary adoption of business rules being developed by CORE, a multi-phase initiative of CAQH.  The CORE rules are streamlining the exchange of administrative data, resulting in improved access to coverage and financial information by providers at the point of care. Certified organizations complete a testing process to confirm that their systems or products comply with the CORE rules, which address both infrastructure and data content.  

"This accomplishment underscores the commitment by our industry and our company to transform the way healthcare data is exchanged through technology," said Vicky Gregg, BCBST president and CEO and a CAQH board member. "A phased approach to collaboratively define and drive adoption of policies and operating rules moves healthcare closer to achieving interoperability while improving the individual patient experience."

"Specifically, the CORE Phase II rules further improve administrative efficiency for our network providers, reduce costs and free up time for physicians and their staff to focus on patients."

The Phase II rules address requirements for electronic connectivity and digital certificates, patient identification, real-time claims status and reporting of year-to-date deductibles. These rules build upon Phase I, which covers eligibility and benefits data.  Both phases align with Federal interoperability efforts.

"We are pleased that BCBST is CORE Phase II certified, as this will improve the flow of administrative information between us," said Jerry L. Miller, M.D., founder of Holston Medical Group.  "CORE brings new efficiencies to sharing patient coverage data and helps streamline administrative processes overall."

CORE participants are finalizing the requirements of Phase III, which will include operating rules for infrastructure that supports referral requests and remittance advice, claims history availability, claim status content and acknowledgements, ID card specifications, and expanded eligibility and financial reporting.