Claim.MD Achieves CORE Certification on Eligibility & Benefits
PECOS, N.M. – April 6, 2022 – Claim.MD, a leading electronic data interchange (EDI) clearinghouse helping to streamline the billing and collection process for providers, payers and software vendors, today announced it has achieved the CAQH Committee on Operating Rules for Information Exchange (CORE®) Eligibility, Claim Status, and Payment & Remittance Certification Seals.
Operating rules and underlying standards enable health plans, healthcare providers and vendors to electronically share large quantities of administrative data quickly, cost effectively and accurately. By specifying the business actions each party must follow in these transactions, the rules reduce costs and improve the efficiency of the nation’s healthcare system.
CAQH CORE has developed the CAQH CORE Eligibility & Benefits, Claim Status, and Payment & Remittance Operating Rules to improve electronic data exchange related to eligibility, benefits and claim status transactions and to streamline provider payment and claim reconciliation. These operating rules establish national expectations for the flow and format of these transactions. With billions of electronic transactions conducted by the healthcare industry each year, CAQH CORE Operating Rules facilitate the seamless and secure exchange of administrative data.
“We’re proud to achieve CORE Certification on Eligibility & Benefits, Claim Status and Payment & Remittance Rules for our platform. This certification signifies customers can trust us to exchange their administrative data safely and securely across the healthcare system,” said Rob Stuart, founder and president of Claim.MD. “Completing this certification not only shows our commitment to furthering interoperability in the healthcare space, but also our commitment to customers having real-time access to information needed to make critical decisions when it matters most.”
The U.S. Department of Health and Human Services selected CAQH CORE to develop national operating rules for HIPAA transactions to ensure that large amounts of data can be shared electronically in a fast and efficient way. Widely viewed as the industry “gold standard,” the CORE Certification Program enables organizations to demonstrate that they and their business partners have adopted and are adhering to the operating rules and their underlying standards, plus going above and beyond what is required.
“Claim.MD is demonstrating industry leadership,” said Robin J. Thomashauer, CAQH President. “Operating rules are most effective when everyone follows them, and today, thanks to Claim.MD, our nation’s healthcare system has taken another important step forward.”
CAQH CORE is a collaboration of more than 130 participating organizations that work together to develop operating rules. Participants represent healthcare providers, health plans, vendors, associations, government entities and the organizations that set standards for healthcare and data exchange. CORE Certification is currently available for all currently published Operating Rule Sets.
For more information about CAQH CORE, visit www.caqhcore.org.
About Claim.MD
Founded in the early 1980s, Claim.MD is a leading EDI Clearinghouse which processes tens of millions of transactions every month. The company’s extensive insurance network links providers to Medicare, Medicaid, Blue, and thousands of commercial insurance companies across the country. Designed with the provider in mind, Claim.MD’s cost-effective and robust product and service offerings are designed to meet provider collection goals. The company’s system of tools is designed to help providers send clean claims the first time, and offer visual tracking to easily see issues and collection trends as industry billing situations change. For more information, visit: https://www.claim.md/.
