HL7, CAQH CORE Join to Boost Admin, Clinical System Interoperability

September 19, 2019 - Health Level Seven International (HL7) and CAQH CORE are working together to improve interoperability between healthcare administrative and clinical systems. 

The two organizations currently conduct complementary work to improve the electronic exchange of data across the healthcare industry. This marks their first collaborative effort.

CAQH CORE was formed by the healthcare industry to promote the adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers, and consumers.

HL7 is a nonprofit standards development organization focused on providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health data that supports clinical practice and the management, delivery, and evaluation of health services.

The two organizations will initially collaborate on three topics:

• Prior Authorization: The prior authorization process can be a labor intensive, time-consuming, and costly administrative burden for providers and payers. It also frustrates patients and can delay care. HL7 and CAQH CORE will collaborate to move the industry towards prior authorization process automation.
• Medical Documentation Exchange: According to the CAQH Index, 84 percent of 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. The two organizations will work to align their respective efforts on the electronic exchange of clinical information and medical documentation.
• Value-Based Payments: The transition to value-based payment models has been complicated by a patchwork of administrative and technical approaches and workarounds. The two organizations will cooperate 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, MD, PhD, CEO of HL7 International. “Our collaboration will enable better alignment and accelerate progress toward interoperability between clinical and administrative systems.”

“Our collaboration will help move the healthcare industry towards greater automation and streamlined business processes,” said April Todd, senior vice president of CAQH. “We are delighted to work with HL7 to address some of the biggest interoperability issues facing the industry.”