Aetna has adopted the Council for Affordable Quality Healthcare (CAQH) program on April 3, 2007 to standardize electronic information exchange for Aetna healthcare providers and insurance members. Aetna implements and supports a standard set of national rules from the CAQH Committee on Operating Rules for Information Exchange (CORE). These rules aim to promote consistent and accurate electronic information exchange among health insurance plans and other health care providers.

CORE rules were designed to simplify the process by which healthcare providers verify member eligibility. Aetna healthcare providers can present a benefit eligibility verification request online and get real-time response from health care organizations certified by CORE.

Aetna aims to streamline business interactions with health care organizations and professionals. Thus, Aetna agreed to exchange benefits eligibility information voluntarily while following predetermined rules and standards. These developments are expected to promote interoperability among Aetna healthcare providers and health plans while improving doctors’ access to administrative information.

Answer by general public — June 16, 2009 @ 2:06 pm

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