Transforming Financial Transactions Through CAQH CORE Operating Rules

November 21, 2014

Categories: Thought Leadership


Simplifying Healthcare AdministrationThe Council for Affordable Quality Healthcare (CAQH) recently hosted a webinar featuring representatives from CNSI and the Washington Healthcare Authority (HCA). The session offered insight into how the CAQH CORE Operating Rules – which aim to support standards, accelerate interoperability and align administrative and clinical activities – are transforming health care financial transactions.

HCA implemented ProviderOne, its state-of-the art Medicaid Management Information System (MMIS), in May 2010. ProviderOne was built and is maintained by CNSI. The system enabled the state to replace a 30-year-old legacy mainframe MMIS with limited functionality and, since its implementation, has made significant progress to become fully compliant with the mandated CORE operating rule requirements to support the 1.6 million clients the system serves. 

During the webinar which had over 200 registrants from across the health care sector, Arvinder Singh, Senior Vice President, HHS Business Unit at CNSI, and Chris Nguyen, of the HIPAA Program at HCA, offered their comments on implementation strategies, lessons learned and best practices in configuring the Washington MMIS to ensure operational compliance.

CNSI and HCA worked together to implement CAQH CORE Phases I, II and III Operating Rules to comply with federal mandates, drive operational efficiencies, streamline electronic health care data exchange and increase interoperability between providers and payers.

The teams worked vigorously to create a business plan identifying HCA’s approach to achieve CORE compliance and identified how a technical platform could expand to support this plan with a complete technical solution.

In addition, HCA used CNSI’s RuleIT® processing tool to implement business policies in business rule engines independently and the existing eCAMS® infrastructure to manage data exchange and service interactions between different systems and applications.

The CNSI team worked closely with HCA to provide innovative solutions that are transforming the state’s MMIS and CNSI remains committed to providing states with the best tools and services to support their health care systems and comply with federal mandates while reducing costs and improving care.

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