CAQH - Council for Affordable Quality Healthcare
CAQH is a non profit alliance of health plans and trade associations collaborating on initiatives that simplify healthcare administration for health plans and providers. This results in a better care experience for patients and caregivers.
CORE – Committee on Operating Rules for Information Exchange
CORE has more than 140 stakeholders that include health plans, providers, vendors, CMS and others. Together they continuously work on operating rules that build on existing standards.
Payers are mandated by legislation to follow the operating rules. Operating rules support standards and specify the business actions each party must adhere to in order to ensure a high volume of reliable transactions occur smoothly. This reduces the amount of time and resources providers spend on administrative functions.
Software vendors and clearinghouses are not mandated to follow the operating rules but, this creates a good business practice.