Newsletter Home Listing

November 2016

A unified approach to collecting, maintaining and disseminating accurate and timely provider data is critical to improving the quality and cost of healthcare delivery, according to a new CAQH white paper, “Defining the Provider Data Dilemma: Challenges, Opportunities and Call for Industry Collaboration.”

Provider data is used to perform a number of essential functions in the healthcare system, such as referring a patient to a specialist, paying insurance claims, credentialing providers and determining sanctions. The real-world effect of poor-quality data on consumers and patients has been recently highlighted through increased regulation to address the quality of health plan directories.

November 2016

More than 100 industry leaders from health plans, healthcare provider organizations, government, consumer groups and others participated in a CAQH-convened Summit on Sept. 29th to develop a path forward for solving healthcare provider data challenges.

The discussion was informed by the CAQH White Paper describing the current state of provider data accuracy and efforts to maintain reliable, high-quality data.

Keynote speaker Shantanu Agrawal, M.D. (pictured above), deputy administrator and director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services, and panelists throughout the day, highlighted areas of concern and described why there is an imperative to address these challenges now. Common themes included the rising costs of healthcare, an evolving provider landscape, new uses for data—such as testing new payment models—and a growing regulatory environment.

November 2016

From greater implementation of the CAQH CORE operating rules to research on the operational needs of the industry to support value-based payments, CAQH CORE continues to identify and implement opportunities that drive the industry toward true interoperability and electronic data exchange. These topics, among others, were highlighted in a recent Town Hall webinar in which CAQH CORE provided progress updates and discussed initiatives underway to enhance the exchange of electronic data in healthcare business transactions.

November 2016

System-wide adoption of electronic funds transfer (EFT) and electronic remittance advice (ERA) has the potential to save the healthcare industry nearly $2.3 billion, according to the CAQH Index. While more than half of these transactions are now conducted electronically, greater adoption would enable health plans and healthcare providers to achieve greater administrative efficiencies and savings.

November 2016

Enrolling healthcare providers in state-operated Medicaid programs and Managed Care Organizations (MCOs) is a cumbersome and expensive manual process involving long lead times, billing and reimbursement issues, as well as significant data entry.

At a presentation for the Medicaid Enterprise Systems Conference, CAQH Director Ann Brisk discussed trends in Medicaid provider enrollment with Steven A. Smith and Dennis Elliot of TennCare, the Tennessee Medicaid program. Smith and Elliot shared the TennCare story of how they streamlined the enrollment and verification process to improve their bottom line.

August 2016

Health plan business partners increasingly recognize that, by becoming CORE-certified, they can help their clients meet requirements under the Affordable Care Act (ACA) to conduct secure and efficient administrative data exchange. Business partners may include vendors, clearinghouses, third party administrators (TPAs) and other entities that help health plans and healthcare providers process transactions more efficiently.

August 2016

The CAQH Index is now recruiting health and dental plans and healthcare providers (including provider practices, hospitals and health systems) to participate in the 2016 Index.

Broad multi-stakeholder participation in the CAQH Index helps establish valuable industry benchmarks on the adoption and cost savings of automated business transactions. By participating as a data contributor, organizations at every stage of adoption provide valuable information, enabling robust monitoring of industry progress and potential cost savings.

This annual reporting is reliable, useful, and actionable for participating organizations and the industry as a whole. Most recently, the 2015 CAQH Index, based on 2014 data, analyzed more than four billion administrative transactions from information submitted by health plans that collectively represented over 118 million covered lives—nearly 45 percent of the commercially insured U.S. population.

May 2016

How does your organization compare to the rest of the healthcare industry in adopting electronic business transactions? The 2015 CAQH Index offers benchmark data, enabling organizations to see where they are excelling and where opportunities for improvement exist.  Specifically, the Index measures adoption rates, cost, and savings associated with the shift from manual to electronic HIPAA transactions between health plans and healthcare providers.

May 2016

As with other segments of healthcare, dental plans and dentists need to operate more efficiently to succeed amidst rising cost pressures and demand for high quality, affordable care. CAQH initiatives are helping the dental industry address business challenges through collaborative efforts that simplify administrative processes and reduce costs. Dental plans and dentists can participate in several CAQH initiatives to streamline their business processes.

May 2016

In a recent letter to the National Committee on Vital and Health Statistics (NCVHS), the multi-stakeholder CAQH CORE Board urged the recommendation of the Phase IV CAQH CORE Operating Rules to the Secretary of the Department of Health and Human Services (HHS).

Pages