Fall 2014
SOLUTIONS NEWS  

CAQH Solutions - the Universal Provider Datasource® (UPD®), SanctionsTrack®, EnrollHubTM, and COB SmartTM – help take unnecessary costs out of the healthcare system by streamlining administrative processes for healthcare providers and health plans.


Get Ready for the Next Generation of Provider Data Collection 

CAQH is making significant improvements to the CAQH Universal Provider Datasource® (UPD) and will launch the next generation UPD as CAQH ProViewTM in February 2015.

CAQH ProView is more intuitive to use and will deliver enhanced functionality to the solution already trusted by 1.3 million healthcare providers as the premier resource for self-reporting demographic and professional information to payers, hospitals, large provider groups and health systems.

Participating organizations will have access to a comprehensive repository of provider data that serves a variety of business needs. Providers will be able to easily submit information through a more intuitive, profile-based design.

Key Features of CAQH ProView

  • Scheduled for release in February 2015, CAQH ProView enhancements will include:
  • Support for additional types of provider relationships such as non-participating and delegated providers.
  • Ability to upload supporting documents directly into CAQH ProView, eliminating the need for paper and fax and improving quality and timeliness of complete applications.
  • Ability to complete and attest to multiple state credentialing applications in one intelligent workflow design.
  • Self-registration in CAQH ProView before a health plan initiates the application process.
  • Enhanced data validation features using recognized industry sources for select data (TIN, NPI, DEA), conforming addresses to the USPS standard, and comparison against the Social Security Administration's list of deceased individuals.
  • Application programming interface (API) capabilities.
  • Additional provider profile information, including the addition of the CMS Disclosure of Ownership questions.

 

Don’t Wait - Prepare now for the launch of CAQH ProView. Click the hyperlinks below for more information.

 

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SOLUTIONS

UPD is the industry-leading solution for provider data management. On average, 7,000 additional providers enter information each month.

Totals as of December 18, 2014:

Providers Using UPD to Reduce Administrative Costs:
1,298,264

Annual Provider Administrative Savings:
$174 million (5.8 million hours)

Paper Applications Eliminated Since Service Inception:
4.3 million

Environmental Impact:
Estimated 153 million pieces of paper or 18,400 trees

 
NEW CAQH SOLUTIONSTM PARTICIPANTS

Beacon Health Solutions
Centurion Tennessee
Christus Health
Compass Health
Eskenazi Medical Group
ExamOne
Family Health America, LC
Fresenius Health Partners, INC
Gemini (Region under Magellan)
Government Management Services
Health Plan of San Mateo
InteCare, INC.
IPN
JSA
Key Medical Group
MCCI Medical Group
MET Healthcare Solutions
Nationwide Vision
Network Solutions, IPA
Norton Health Care
Peace River Center
Physicians of Southwest
    Washington, LLC
Rayn Healthcare Alliance
Sightcare
Special Care Management, LLC
Tenet Health
TriWest Healthcare Alliance
US Physical Therapy
US Vision
Vicinitas Cancer Care, LLC

Increase EFT Enrollments with EnrollHub  

CAQH and NACHA – The Electronic Payments Association recently presented a joint webinar exploring the value of electronic funds transfer (EFT) for both healthcare providers and health plans. “Accelerating Provider Adoption of EFT” presents the state of adoption for EFT and captures various ways that the industry is working together to improve interoperability across the healthcare system.

The webinar also explains how EnrollHubTM, a CAQH SolutionTM, helps payers move closer to universal electronic funds transfer (EFT) and electronic remittance advice (ERA) by simplifying the enrollment process for their entire provider network.

Providers sign up one time, in one place, through one application, making it easy to enroll in EFT and ERA with multiple health plans at once. Over 50,000 providers are already using EnrollHub.

View the webinar. Or learn more about how to participate in EnrollHub by emailing eft@caqh.org.

 

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COB Smart Offers New Tool to Simplify COB Lookup 

Now health plans that utilize COB SmartTM, a CAQH SolutionTM, can quickly get coordination of benefits (COB) information for their members through the COB Smart payer portal. COB Smart is identifying COB for more than 120 million individuals. The payer portal is available for no additional charge, participating organizations can directly access COB Smart information easily and securely through their own network using a standard web browser.

The COB Smart payer portal enables individual member search by returning COB details for members with overlapping coverage through another payer. The results include complete information needed to contact the other covering payer. Instant report downloads are also available.

To begin using the COB Smart payer portal, participating health plans assign a single administrator. This administrator can then easily arrange access for others within the organization as needed. CAQH also provides a User Guide and basic training tools for payers to get started using the portal.

Information on connecting to the COB Smart payer portal is available from CAQH. Email cob@caqh.org.

 

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Did You Know?
Get the Full Perspective on Providers 

Health plans and hospitals looking to ease network credentialing have a helpful solution at their fingertips. CAQH offers users an automated process to track licensing boards, OPM and OIG, and match provider disciplinary actions. Currently available as an add-on module to the Universal Provider Datasource® (UPD), SanctionsTrack® can help reduce hours of staff time, eliminate redundant processes and improve results related to sanctions monitoring.

NCQA has deemed the CAQH solution a primary source for ongoing sanctions monitoring. SanctionsTrack consolidates and electronically reports all provider sanctions and related license actions in the US.

Contact Scott Everline to schedule a consultation and brief demonstration.

 

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