Retrace, the first native-built AI healthcare clearinghouse to provide real time connectivity between dental practices and payers, today announced that they achieved the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE®) Eligibility, Health Care Claim, Claim Status, and Payment & Remittance Certification Seals.
Operating rules and underlying standards enable health plans, healthcare providers, and vendors to electronically share large quantities of administrative data quickly, cost effectively, and accurately. By specifying the business actions each party must follow in these transactions, the rules reduce costs and improve the efficiency of the nation’s healthcare system.
The CORE Certification Seal was awarded after Retrace successfully completed a thorough and independent testing process and a subsequent application review. This ensures that users can securely process electronic queries within seconds, providers will receive consistent patient eligibility, benefits, claims, payments and remittance information that follow a common set of national operating rules.
CAQH CORE developed the CAQH CORE Eligibility & Benefits, Health Care Claim, Claim Status, and Payment & Remittance Operating Rules to improve electronic data exchange related to eligibility, benefits, claim submission, claim status, payment, and remittance transactions. This streamlines provider payment and claim reconciliation, and these operating rules establish national expectations for the flow and format of these transactions. With billions of electronic transactions conducted by the healthcare industry each year, CAQH CORE Operating Rules facilitate the seamless and secure exchange of administrative data.
CORE Certification confirms that Retrace can exchange electronic healthcare information for eligibility, health care claims, benefits, claims status, electronic funds transfer, and electronic remittance advice in conformance with the CAQH CORE Operating Rules.
“Insurance companies have invested hundreds of millions of dollars into their current claims infrastructure and business process optimization; therefore, any changes to that existing system can create a cascade of issues for everyone already invested,” said Retrace CEO and founder Dr. Ali Sadat. “Instead of trying to change legacy systems, the best way to improve them is to build upon the groundwork that’s already been established. Trusted interactions with the existing ecosystem allow us all to work within the current framework and spend our resources adding value to what’s come before as opposed to reinventing the wheel for every new implementation. The ROI is clear. These certifications ensure that Retrace drastically reduces implementation times from years to just days all while producing better, faster, and cheaper outcomes quickly and efficiently.”
The U.S. Department of Health and Human Services selected CAQH CORE to develop national operating rules for HIPAA transactions to ensure that large amounts of data can be shared electronically in a fast and efficient way. Widely viewed as the industry “gold standard,” the CORE Certification Program enables organizations to demonstrate that they and their business partners have adopted and are adhering to the operating rules and their underlying standards, plus going above and beyond what is required.
Data from the 2020 CAQH Index found that, of the $372 billion spent on administrative complexity in the United States healthcare system, $39 billion, or 10 percent, is spent conducting administrative transactions tracked by the CAQH Index. Of the $39 billion, the industry can save $16.3 billion, or 42 percent of existing annual spend, by transitioning to fully electronic transactions.
“Retrace is demonstrating industry leadership,” said Robin J. Thomashauer, CAQH Executive Director. “Operating rules are most effective when everyone follows them, and today, thanks to Retrace, our nation’s healthcare system has taken another important step forward.”
CAQH CORE is a collaboration of more than 130 participating organizations that work together to develop operating rules. Participants represent healthcare providers, health plans, vendors, associations, government entities, and the organizations that set standards for healthcare and data exchange. CORE Certification is currently available for all currently published Operating Rule Sets.
For more information on Retrace, visit www.retrace.ai.
For more information about CAQH CORE, visit www.caqhcore.org.
About Retrace
Founded in 2016, Retrace enables real-time connectivity between payers, providers and patients to provide instant value-based payments rooted in quality measures. Retrace’s network and Intelligent Automation solutions streamline the complexity of dental administration for payers, providers and patients, with scalable end-to-end services powered by AI technologies to deliver high quality, simple and predictable healthcare. Retrace’s investors include Intel Capital and SoftBank Ventures Asia.
Retrace is privately held and headquartered in San Francisco, California. To learn more, visit www.retrace.ai.
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