A catalyst for positive change, CAQH members collectively develop and implement administrative solutions that produce meaningful, concrete benefits – for physicians, allied health professionals, their staffs, patients and plans.
Universal Provider Datasource (UPD)
The CAQH Universal Provider Datasource (UPD) is achieving its vision of simplified data collection by reducing paperwork and millions of dollars of annual administrative costs for more than 1 million providers and over 700 health plans and networks across the United States.
Launched in 2002, UPD allows registered physicians and other health professionals in all 50 states and the District of Columbia to enter their information free of charge into a single, uniform online application that meets the data needs of health plans, hospitals and other healthcare organizations. Approximately 7,000 new providers begin using the service each month. The provider data-collection service streamlines the initial application and re-credentialing processes, reduces provider administrative burdens and costs, and offers health plans and networks real-time access to reliable provider information for claims processing, quality assurance and member services, such as directories and referrals.
UPD is supported by the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, America’s Health Insurance Plans, the American Health Information Management Association, and other provider organizations. Indiana, Kansas, Kentucky, Louisiana, Maryland, Missouri, New Jersey, New Mexico, Ohio, Rhode Island, Tennessee, Vermont and the District of Columbia have adopted the CAQH Standard Provider Application as their mandated or designated provider credentialing form. The UPD form meets all related URAC, National Committee on Quality Assurance and the Joint Commission on Accreditation of Healthcare Operations standards.
SanctionsTrackTM, UPD’s add-on feature, is quickly identifying providers with sanctions and/or disciplinary actions through daily updates drawn from all state licensing boards, the Office of Inspector General, Office of Personnel Management and Medicare/Medicaid sources -- more than 480 in all.
Click here to learn more about Universal Provider Datasource.
Committee on Operating Rules for Information Exchange (CORE)
CAQH CORE Vision: An industry-wide facilitator of a trusted, simple and sustainable healthcare data exchange that evolves and aligns with market needs.
CAQH CORE Mission: Drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers and consumers.
CAQH CORE is an industry-wide stakeholder collaboration committed to the development and adoption of national operating rules for administrative transactions. The more than 140 CORE Participants represent all key stakeholders, including providers, health plans, vendors, clearinghouses, government agencies, Medicaid agencies, banks and standard development organizations. Working in collaboration, they are building consensus on a set of operating rules that will:
- Enhance interoperability between providers and payers
- Streamline eligibility, benefits, and claims data transactions
- Reduce the amount of time and resources providers spend on administrative functions – time better spent with patients
Operating rules build on existing standards to make electronic transactions more predictable and consistent, regardless of the technology. Rights and responsibilities of all parties, security, transmission standards and formats, response time standards, liabilities, exception processing, error resolution and more must be clearly defined in order to facilitate successful interoperability. Beyond reducing cost and administrative hassles, operating rules foster trust among all participants.
Click here to learn more about CAQH CORE.