CORE paying dividends.(Health Plans)

The Council for Affordable Quality Healthcare (CAQH) reports that healthcare providers and health plans using the phase I rules of its Committee on Operating Rules for Information Exchange (CORE) showed dramatic cost savings, accelerated use of real-time electronic transactions, improved claims verifications and reduced claims denials. The estimated potential savings from an industrywide implementation of the CORE phase I rules are more than $3 billion in three years.

Conducted for CAQH by IBM's Global Business Services, the study assessed six CORE-certified health plans that represent 33 million covered lives, as well as leading provider groups and vendors using the CORE phase I rules.

Key findings of the study: Electronic insurance eligibility verifications took approximately seven minutes less than telephone verifications, saving providers $2.10 per verification; and providers working with CORE-certified health plans saw 10 percent to 12 percent fewer claims denials, resulting in improved practice payment.

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