August 2016

Participate in the 2016 CAQH Index

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.

Health Plan Business Partners Find Value in CAQH CORE Certification

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.

OTHER NEWS

 

New Webinar Resource: Improving Provider Data Accuracy with DirectAssure

In a recent webinar, United Healthcare and CAQH shared how DirectAssure helps both plans and providers meet new directory requirements. The webinar provided an update on federal requirements and explained how the CAQH Solution is enabling health plans to comply with the new provider directory regulations from the Centers for Medicare and Medicaid Services. Bruce Thompson, vice president for provider data strategies at United Healthcare, also discussed his experience using DirectAssure and how it has helped his team work through the challenges of updating provider data and meet the new requirements. View a recording of the webinar


New On-Demand Webinar: Get it Right the First Time – Streamlining the Coordination of Benefits Process

Michael Seavers, Senior Director, Operations at Capital Blue Cross (CBC) recently teamed with CAQH in a webinar to discuss how they have improved payment accuracy, reduced “pay and chase” and limited claims denials for members with overlapping coverage with COB Smart, a CAQH solution.  The health plan estimated it will save more than $8 million over five years by using this CAQH Solution, $2.5 million in the first year alone. View a recording of the webinar.


Modern Healthcare Selects CAQH as a Best Place to Work in Healthcare

CAQH has been named by Modern Healthcare as one of its Best Places to Work in Healthcare for 2016. The program recognizes 100 organizations and companies across the nation for the ability to “empower their employees to provide patients and customers with the best possible care, products and services.” Modern Healthcare selects the organizations based on feedback submitted by employees through an engagement and satisfaction survey, as well as a review of company policies, practices and demographics.  More information about the recognition will be available in October when Modern Healthcare publishes specific rankings. To learn about career opportunities with CAQH, visit http://www.caqh.org/about/careers.


UPCOMING: CAQH CORE Town Hall National Webinar

August 24, 2016, 2:00 PM EDT

CAQH CORE Town Hall webinars provide the industry with an update on recent CAQH CORE activities related to development and/or implementation of healthcare operating rules. Learn about federally mandated and voluntary CAQH CORE Operating Rules, voluntary CORE Certification, and much more. Register for the Webinar.


New CAQH Staff

 
Helina Gebremariam, Senior Associate

Helina assists the CORE Code Combinations Task Group and helps to build out the CAQH CORE Participant Relations functions. Most recently, she was at Avalere Health where she helped design and launch a syndicated research product to broaden life sciences companies' understanding of public and commercial payment and delivery reform efforts, their effect on provider behavior and key implications for business decisions.

Cheryl Hughes, Accreditation Manager

Cheryl is supporting the new CAQH primary source verification solution. Her efforts help maintain CAQH CVO certification status with the National Committee for Quality Assurance, coordinating quality improvement plans, and supporting compliance needs with the Centers for Medicare and Medicaid Services and states. Most recently Cheryl was at Privia Health as a credentialing manager, and has extensive credentialing experience with health systems, management services srganizations, and group practices.

Mark McNeil, Technology Manager

Mark plays a role in the interface between internal CAQH product managers and external solution providers. He shares the responsibility for creation and enhancement of transformative healthcare solutions. Previously, he was a Senior Development Manager with Harris Computer Systems (formerly QuadraMed) where he was responsible for developing enterprise hospital financial information systems on a variety of technology platforms. 

Neeta Sonnakul, QA Engineer

Neeta is a member of the CAQH Technology Team working on quality assurance efforts. She has implemented automated testing solutions and designed and deployed automation frameworks on web-based application platforms using several of the latest tools and technology.  Prior to joining CAQH, she worked for seven years as a lead specialist in project management at Verizon Business.

Leslie Wade, Marketing Manager

Leslie is managing marketing activities for CAQH Solutions, working closely with the product management and business development teams. She joins CAQH from Inovalon where she was responsible for marketing risk adjustment and clinical and quality outcomes solutions to health plans participating within the Medicare Advantage, Medicaid, Commercial Exchanges, and Accountable Care Organizations marketplace.

Lesley Ward, Manager, Communications

Lesley manages media relations activities and develops content for CAQH communications channels. She most recently held positions at the Association of American Medical Colleges where she managed outreach and communications for the revised Medical College Admission Test and the association’s media relations program. 


CAQH in the News

Modern Healthcare: Best Places to Work in Healthcare for 2016

Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model

How the Affordable Care Act Influenced CORE Certification

Clearinghouses and IT Vendors Join Rapidly Growing List of Entities Becoming CAQH CORE Certified