CAQH Initiative to Speed Physician Access to Patient Insurance Coverage Data

The benefits of an interoperable healthcare system are well understood. The availability of information in real-time at the point of care can reduce medical errors, allow physicians and their patients to make informed decisions about treatment options, and reduce administrative burdens. The challenges are equally well understood. Technology adoption rates, data security, and inconsistency associated with transactions and interactions between stakeholders are limiting the ability to realize a complete solution.

Through CORE, CAQH is working to make it easier for physicians and hospitals to access eligibility and benefits information for their patients at the point of care. CORE operating rules will allow providers to submit a request, using the electronic system of their choice, to obtain a variety of coverage information for any patient and from any participating health plan. Providers will receive more consistent and predictable data, regardless of health plan.

CAQH