HL7 International, responsible for the creation of the FHIR interoperability standard, has partnered with CAQH CORE to collaborate on ways to improve automation and interoperability between administrative and clinical systems. The two organizations hope to come together to improve digital information exchange throughout the healthcare industry. The collaboration will address 3 key issues; prior authorization, exchange of medical information, and value-based payments.
According to the CAQH Index, 84% of medical documents or attachments are still exchanged manually. The manual process inevitably creates variations between documents, which end up containing too much or too little information, or incorrect information at journey’s end. Sorting through these errors is a major source of delay for prior authorizations, an already time-consuming and labor-intensive process. Currently, prior authorizations are a major cause of patient frustration and delayed care.
The value-based care model intends to alleviate overall patient frustration with the healthcare system, but the transition to value-based payment models has been hindered by previously necessary technical work arounds to connect administrative and clinical systems. Addressing these issues should help save providers both time and money, while improving interoperability between administrative and clinical data.
HL7 and CAQH CORE will work together to automate the prior authorization process in a comprehensive manner. The end goal is to improve patient care and limit frustration for all stakeholders. HL7 International CEO Charles Jaffe says “HL7 and CAQH CORE have made great strides to improve the exchange of information in the healthcare continuum. Our collaboration will enable better alignment and accelerate progress toward interoperability between clinical and administrative systems.”
CAQH CORE is an industry-led organization formed to create and adopt healthcare operating rules that align administrative and clinical activities among providers, payers and consumers. HL7 International is a non-profit entity dedicated to developing a comprehensive framework for healthcare data interoperability worldwide. Exscribe is proud to be an organizational member of HL7 International.