Recently, I attended the CAQH CORE (www.caqh.org) webinar discussing the issues and events expected to be dealt with during 2015. This organization is responsible for establishing the operating rules for the exchange of HIPAA transactions. While everyone is focused on ICD10, I believe that the work being performed through this organization will have a major impact on the healthcare industry as well.
The HIPAA legislation, back in 1996, established the initial specs for the electronic exchange of information used in specific healthcare transactions. As part of the ACA, operating rules are being established through CAQH CORE to require all healthcare business partners to use these transactions instead of alternative methods for documenting these business processes. For fifteen years, the intended benefit of using these transactions has not been realized. The reason is not that the standards are not adequate, but that they are of limited benefit unless everyone uses them. Continue reading