Electronic Health Reporter

CAQH CORE and Health Level Seven International (HL7) announce a collaboration to address long-standing healthcare industry challenges by accelerating automation and improving interoperability between administrative and clinical systems. This is the first time these two organizations, which conduct complementary work to improve the electronic exchange of data across the healthcare industry, have collaborated on solutions to specific technical and administrative burdens.

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

The two organizations will initially collaborate in three areas:

1. 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.
2. 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.
3. 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, MD, PhD, CEO, HL7 International. “Our collaboration will enable better alignment and accelerate progress toward interoperability between clinical and administrative systems.”