; Horizon Blue Cross Blue Shield Of New Jersey Recognized For Its Efforts To Ease And Improve The Health Care Billing System
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Press Release

Horizon Blue Cross Blue Shield Of New Jersey Recognized For Its Efforts To Ease And Improve The Health Care Billing System

October 9, 2013

NEWARK – CAQH® has recognized Horizon BCBSNJ for its efforts to improve and streamline the way it shares and administers electronic billing transactions with its providers. The voluntary certification awarded by CAQH’s Committee on Operating Rules for Information Exchange (CORE®), shows that Horizon BCBSNJ has taken the steps to meet the first two phases of the CAQH CORE Operating Rules, which support best practices for electronic billing.

“Providers and patients want and need to know the patient cost of a particular medical procedure or visit in real time,” says Mark Barnard, Senior Vice President, Service Division, Horizon BCBSNJ. “Since implementing and becoming certified on the CAQH CORE rules, we are able to bring more clarity to financial aspects of health encounters. Our members and providers are now able to have more informed conversations about billing, and we are working toward a more efficient process that reduces administrative costs for everyone in the payment cycle.”

The Phase I and Phase II CAQH CORE Operating Rules support electronic eligibility and claim status inquiries, streamlining and bringing uniformity to these essential administrative transactions between health care providers and health plans. In addition, the rules simplify interoperability for all trading partners.

“As a longtime participant in the CAQH CORE rule-writing process, Horizon is a leader in the movement to take wasteful cost and needless frustration out of the healthcare system,” says CAQH CORE Board Chair, George Conklin, CIO, CHRISTUS Health. “These certifications bring substantial benefits to the hospitals, healthcare systems, physician offices, and other providers caring for Horizon members. They verify that Horizon has successfully implemented the rules to give providers electronic access to real-time, robust eligibility and claim status information.”

Together, the Phase I, II, and III CAQH CORE Operating Rules, most of which have been adopted under federal law implementing the Patient Protection and Affordable Care Act (ACA), are estimated to save as much as $15 billion in processing costs over 10 years. Certification accelerates the return on investment by promoting broader use of the operating rules, driving value for all trading partners in the data exchange.

About Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a tax-paying, not-for-profit health services corporation, providing a wide array of medical, dental, and prescription insurance products and services.  Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving 3.7 million members with headquarters in Newark and offices in Wall, Mt. Laurel, and West Trenton.  Learn more at www.HorizonBlue.com.

The CAQH Committee on Operating Rules for Information Exchange (CORE) is a multi-stakeholder industry collaboration developing operating rules that streamline administrative transactions. Over the past eight years, CAQH CORE participation has grown to more than 140 organizations. CAQH CORE has a proven track record of delivering a strong return on investment that is driven by widespread adoption and voluntary certification of operating rules. CAQH CORE was designated by HHS to author three sets of federally mandated operating rules under ACA. To learn more about CAQH CORE, visit www.caqh.org/benefits.php.

About CAQH
CAQH, formerly known as the Council for Affordable Quality Healthcare, serves as a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers. CAQH solutions help promote quality interactions between plans, providers, and other stakeholders; reduce costs and frustrations associated with healthcare administration; facilitate administrative healthcare information exchange; and encourage administrative and clinical data integration. Visit www.caqh.org for more information.


The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 105 million members – one-in-three Americans.  For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.