HEALTHeNET RECEIVES CAQH CORE CERTIFICATION

First health information exchange in the country with this designation

HEALTHeNET, the administrative equivalent of HEALTHeLINK, Western New York’s clinical information exchange, today announced it has received CAQH Committee on Operating Rules for Information Exchange (CORE) Certification, Phase I and II, for its clearinghouse product. CAQH, which serves as a catalyst for industry collaboration on initiatives to simplify health care administration, certifies and awards CORE Certification to entities that create, transmit or use the administrative transactions in accordance with the CAQH CORE Operating Rules. CORE Certification means HEALTHeNET has demonstrated that its IT system is operating in conformance with Phase I and II of the CAQH CORE Operating Rules.

HEALTHeNET provides secure access to administrative information from the health plans to assist the provider community in day to day business operations. With HEALTHeNET, health care providers and office staff are able to verify the status of their patients’ insurance eligibility, benefits and claims. Users are also able to initiate a referral and inquire if one is in place. Current health plans and payers connected to HEALTHeNET include BlueCross BlueShield of Western New York, Independent Health, Univera Healthcare, Health Now, BlueShield of Northeastern New York, Fidelis Care of New York, BlueCross BlueShield Association, New York State Medicaid and NOVA Healthcare Administrators.

“Since 2001, HEALTHeNET has been an essential administrative tool in physician offices and hospitals throughout Western New York and it laid the collaborative groundwork for our clinical health information exchange, HEALTHeLINK,” said Dan Porreca, executive director. “While the CORE Certification process is voluntary, using the Phase I and II CAQH CORE Operating Rules provides assurance to our HEALTHeNET users that we are operating at the highest level in providing consistent and secure access to administrative health data.”

CAQH is working to simplify health care administration through industry initiatives that promote quality interactions between plans, providers and other stakeholders; reduce costs and frustrations associated with health care administration; facilitate administrative health care information exchange; and encourage administrative and clinical data integration. Established in 2005, CAQH CORE is a multi-stakeholder collaboration of more than 130 organizations representing providers, health plans, vendors, government agencies and standard-setting bodies, developing operating rules to simplify health care administrative transactions.

“CORE Certification shows the industry that HEALTHeNET is ready and able to transmit streamlined eligibility and claim status transactions,” said Gwendolyn Lohse, deputy director of CAQH and managing director of CAQH CORE. “The full value of the CAQH CORE Operating Rules is realized when all participants touching the data – whether they are health plans generating data, clearinghouses transmitting or displaying the data, or providers receiving the information – are following the Operating Rules. Given HEALTHeNET’s role in connecting the various stakeholders, providers and hospitals in Western New York will benefit from these recent achievements.”

For more information on HEALTHeNET visit www.wnyhealthenet.com or call 716-206-0996.