HealthFusion® is a certified Phase 1 CAQH CORE clearinghouse,
a distinction that few companies in our industry have earned.
What is CORE?
CORE (Committee on Operating Rules for Information Exchange) is an initiative sponsored by CAQH (Council for Affordable Quality Healthcare), an unprecedented nonprofit alliance of health plans and trade associations. CAQH is a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers.
What are the Standards for CORE Participants?
CORE participants agree to a set of security standards and business rules for using and processing transactions. CORE encourages an interoperable network (like the ATM machines in the banking industry). Participants must commit and be certified regarding the following parameters:
- Response timing standards
- Rights and responsibilities of all parties
- Transmission standards and formats
- Error resolution
- Exception processing
- Security.
Who Participates in CAQH?
Over 100 organizations representing all aspects of the industry are working with CAQH:
- 19 health plans
- 13 providers
- 5 provider associations
- 18 regional entities (Regional Health Information Organizations or RHIOs, standard-setting bodies, and other associations)
- 34 vendors (Clearinghouses and Practice Management System developers)
- 5 other groups (consulting companies and banks)
- 8 government entities, including:
- Centers for Medicare and Medicaid Services
- Louisiana Medicaid / Unisys
- TRICARE
- US Department of Veteran Affairs
- Minnesota Department of Human Services.
CORE participants maintain eligibility and benefits data for over 130 million lives – or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.
What Does HealthFusion's CORE Certification Mean to You?
It means that a third party has reviewed the HealthFusion system and, for Phase 1 of the CORE process, HealthFusion is a certified clearinghouse. We are committed to interoperability because it streamlines the provision of healthcare and benefits our provider clients – and our CORE certification documents and verifies that commitment.
