March 2016

CAQH is Simplifying Provider Directory Maintenance with DirectAssure

March 2016

Responding to consumer concerns about the quality of healthcare provider directories, a number of federal and state directory requirements have recently gone into effect. Health plans must now regularly update and confirm the accuracy of their provider information, or face potential penalties. CAQH is helping health plans address these requirements with the launch of DirectAssure, which works in concert with CAQH ProView to improve provider directory data.

Provider Data: A Fundamental Need for Collaboration

March 2016

Reliable provider data is necessary not only for care delivery, but also for efficient financial processes in healthcare. The need for accurate and timely provider data is continuing to grow. The healthcare industry is discovering new ways to share responsibility for quality provider data as government programs expand, new payment models evolve, cost pressures heighten and demands for transparency increase.

OTHER News


Number of CORE Certifications Continues to Increase

More than 260 CORE Certifications have now been awarded to health plans, hospitals and health systems, clearinghouses and vendors. CORE Certification shows that an entity has demonstrated its IT system or product is operating in conformance with a specific phase(s) of the CAQH CORE Operating Rules.

View the complete list of CORE-certified organizations.


Voluntary CORE Certification National Webinar - Basics of Certification

March 09, 2016 | 2:00 PM ET

What is the value of pursuing Voluntary CORE Certification? Is there a strategic reason to be conformant with the operating rules beyond compliance? Learn more and get a step by step guide through the CORE Certification process and Certification testing.

Register Now.


New Phase IV CAQH CORE Operating Rules National Webinar - Focus on Infrastructure

March 22, 2016 | 2:00 PM ET

The Complete Set of Phase IV CAQH CORE Operating Rules, which address four HIPAA transactions including Claims, Prior Authorization, Enrollment, & Premium Payment, were approved through the CAQH CORE voting process in September 2015. This webinar will give a detailed overview of the four Phase IV Infrastructure Rules as well as provide an update of new resources and tools to support industry implementation of the new Phase IV operating rules. 

Register Now.


Webinar: Healthcare Industry Trends in Electronic Business Transaction Adoption, Costs and Savings

March 30, 2016 | 2:00 PM ET

In this webinar, CAQH will release key findings from the latest 2015 CAQH Index. Learn about the progress made from the industry shift from manual to electronic claims-related transactions, as well as the costs, savings and gaps that remain. The Index analyzes the most common business interactions between health plans and healthcare providers, including claim submission, eligibility and benefit verification, prior authorization, claim status inquiries, claim payment, remittance advice and coordination of benefits.

Register Now.


New CAQH Staff

Caroline Massie, Communications Associate

Caroline is supporting social and traditional media, website, conferences, and the crafting and distribution of communications and marketing materials. Most recently, she worked as an editor with Hanley Wood, a media and marketing services company in the design and construction industry.

David McLaurin, Credentialing Specialist

David has joined CAQH to support delegation needs with the expansion of CAQH ProView. Previously, he worked in the credentialing department for Health Net Federal Services and the network development area for Ceridian. 

Kelly McNair, Account Manager

Kelly manages participating organization accounts to help streamline their administrative business processes. Prior to joining CAQH, Kelly worked at Avalere Health, a healthcare consulting firm in DC, where she managed client memberships with Avalere’s Business Intelligence Products.

Raynard Washington, PhD, MPH, Senior Manager, Research & Measurement

Raynard is responsible for daily management of the CAQH Index and conducting research activities to support CAQH thought leadership. Prior to joining CAQH, he served as a Health Research Scientist for the Agency for Healthcare Research and Quality (AHRQ), HHS.  

Nickolaos Droukas, Outreach Specialist
Jessica Knight, Outreach Specialist

These new CAQH staff are now part of an Outreach Specialists team that provides education, support, and marketing information to healthcare providers and other users of CAQH Solutions.

Nickolaos (Niko) most recently worked as a Membership Supervisor and Membership Representative for the Pacific Science Center in Seattle, WA. 

Jessica (Jessie) formerly worked as an ESL Instructor for Open English and also as a Language Testing Manager for Alta Language Services.


In the News

New insurer database tool could cut back on phone calls to physicians

CAQH effort aims to clean up insurers’ provider directories

CAQH launches new solution to improve provider directory data quality

Why a national solution is needed for provider directories

Health insurers could face fines starting Jan. 1 for mistakes in provider directories

Health insurers to face fines for not correcting doctor directories

4 Trends for provider operations & provider network administrators in 2016

The Healthcare Administrative Technology Association (HATA) announces new online ERA EFT Resource Library

FierceMarkets announces finalists in 2015 Fierce Innovation Awards: Payer Edition