CAQH CORE, HL7 to Collaborate on Interoperability Between Administrative, Clinical Systems

Industry organizations CAQH CORE and HL7 have announced a collaboration to improve interoperability between administrative and clinical systems. This is the first time these two organizations have collaborated on solutions to specific technical and administrative burdens.

The two organizations will initially collaborate in three areas:

• Prior Authorization: Currently, the prior authorization process is a labor-intensive, time-consuming, and costly administrative burden for providers and payers. It also frustrates patients and, in some cases, delays care. HL7 and CAQH CORE will collaborate to move the industry towards end-to-end automation of the prior authorization process.

• Exchange of Medical Documentation: According to the CAQH Index, 84 percent of attachments, or documents that prove medical necessity, are exchanged manually and often contain too much, too little, or the wrong type of information. This delays prior authorizations, hinders the transition to value-based payments, and costs plans and providers time and money. HL7 and CAQH CORE will work to align their respective efforts to support the electronic exchange of clinical information and medical documentation.

• Value-Based Payments: The transition to value-based payment models has been slowed by a patchwork of administrative and technical approaches and work-arounds. HL7 and CAQH CORE will work together to address the interoperability challenges causing administrative burden for innovative payment models.

“HL7 and CAQH have made great strides to improve the exchange of information in the healthcare continuum,” said Charles Jaffe, M.D., Ph.D., CEO of HL7, in a prepared statement “Our collaboration will enable better alignment and accelerate progress toward interoperability between clinical and administrative systems.”