SEATTLE – Two separate projects aimed at facilitating the sharing of patient eligibility and other administrative data are continuing to move toward a unified approach to sharing patient information.
Last month, the clearinghouse product of RxHub was deemed to be in compliance with the first phase of rules promulgated by the Committee on Operating Rules for Information Exchange, or CORE.
The CORE rules are being developed by CAQH, a not-for-profit alliance of health plans and trade associations that’s taking a lead role in streamlining the sharing of administrative data.
RxHub operates a national network that sends medication history and pharmacy benefit information to caregivers at the point of care on an estimated 200 million Americans. Cooperation between CORE and RxHub is crucial to those who hope to synchronize interoperability efforts in the medical and pharmacy sectors.
“Aligning medical and pharmacy insurance eligibility standards is a natural extension of the work being done by CAQH and RxHub,” said Robin J. Thomashauer, executive director of CAQH. “RxHub’s PRN certification means providers will now have even more consistent access to both medical and pharmacy eligibility and coverage information at the point of care.”
The capability to share eligibility information meshes well with RxHub’s goal of facilitating electronic prescribing, said Mark Gingrich, its CIO. Because some insurers provide both health and pharmacy coverage, achieving interoperability in sharing eligibility information of all types is important, he said.
“Eligibility is a key transaction for the industry, and it makes sense that whatever we have out there, from an interoperability standpoint, works for both,” Gingrich said.
The Phase I rules for which RxHub’s product received certification govern the exchange of several eligibility and benefits data elements, including whether a patient has pharmacy coverage.
CORE’s members soon will be voting to accept the final requirements for Phase 2 certification and will begin work on the requirements intended for Phase 3, said Gwen Lohse, director of the CORE project.
CORE builds on existing national standards with the intent of reducing costs and simplifying administration by getting all participants to share standards to achieve a return on investment. Lohse said the integration of pharmacy and medical efforts is crucial to success.
“This demonstrates what the two organizations are trying to do within their own realms and also by working cooperatively,” she said.