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UPD STATS AT A GLANCE
UPD is the industry utility for self-reported provider data collection. On average, 7,000 providers join the service each month.
Totals as of December 19, 2013:
Providers Using UPD to Reduce Administrative Costs:
1,191,683
Annual Provider Administrative Savings:
$160 million (5.4 million hours)
Paper Applications Eliminated Since Service Inception:
4 million
Environmental Impact:
Estimated 141 million pieces of paper or 16,900 trees
NEW UPD PARTICIPANTS
Absolute Total Care
Alpha Care
Ambay Health Network
American Well Corporation/
Online Care Network
Apogee Health Partners
Argus Dental and Vision
Association of Primary Care
Physicians
BCBS of Tennessee
BeHealthy America
California Health and Wellness
Community Health Choice, Inc.
Essence Healthcare
Evergreen Health Cooperative Inc.
First Coast Advantage
Health First Network, Inc. Florida
iCare Health Options/Florida
Optometric Physicians Network
Institute for Family Health
Kentucky Health Cooperative Inc
Land of Lincoln Healthcare
Leon Medical Centers Health
Plans
Lonestar Circle of Care
Medstar Family Choice Inc.
MHC Partners
Northeast Alabama Physicians
Northeast Alabama Primary
Healthcare
Oakland Physician Network
Services
Oscar Insurance Corporation
Planned Parenthood of Wisconsin
Premier Health Plan
Premier Physician Support
Services
Prime Community Care of Central
Valley
ProCare Health
Sandhills Center
South Florida Vision 2020 EyeCare
Plan
The Physicians Network
Thrive Health Plan
Ultimate Health Plans, Inc.
Vale-U-Health
Vanderbilt University
Vantage Health Plans
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Launched in 2002 by CAQH, the Universal Provider Datasource® (UPD®) is achieving its vision of simplified provider data collection, maintenance, and distribution by reducing paperwork and millions of dollars of annual administrative costs for nearly 1.2 million providers and more than 700 health plans and hospitals across the United States.
New Jersey Approves UPD as a Primary Source for Provider Credentialing and Directory Information
The New Jersey Department of Banking and Insurance has approved use of the Universal Provider Datasource (UPD) as a primary source of provider credentialing and directory information. Health plans are required to ensure the information in their provider directory is based on CAQH data or the most recently submitted information from the provider. The ruling gives health plans and providers a universally reliable and trusted source of essential administrative data and eliminates repetitive tasks that add cost to the healthcare system.
Additionally, the rule sets timeframes for the provider credentialing process and provider directory updates. For instance, the rule requires health plans to complete the provider credentialing process within 90 days of receiving a completed provider application. It also specifies a 20-day deadline for health plans to update electronic directories when UPD information changes or when inaccuracies are identified.
The need for accurate provider information is well understood across the healthcare system. This approach by New Jersey underscores the quality of data found in UPD, positioning this source as equivalent to receiving information directly from the provider.
For more information about UPD, contact Christine Stroup at cstroup@caqh.org.
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Directory Maintenance Report Eases Provider Data Changes
CAQH launched the Directory Maintenance Report (DMR) in 2012 to simplify the process for capturing provider data changes. The Report eases the integration of data changes into the systems of participating organizations and also helps address the New York Attorney General requirements for provider directory quality.
The DMR reviews active rosters from participating organizations to determine which providers had attestations in the previous week, and also to identify which data elements have been changed, added and deleted. The initial data elements being reviewed were chosen based on their appropriateness for inclusion in a member directory. Additional elements have been added to the DMR to address the needs of Medicaid enrollment.
Based on user feedback, CAQH recently launched enhancements to the DMR. The enhancements add flags for locations where providers are currently practicing and also lock sequence IDs so that data can be more easily mapped between the corresponding record and the system used by the participating organization.
Available at no additional cost to participating organizations, the DMR is refreshed weekly and can be downloaded through the FTP site or by logging in to the CAQH UPD account and going to the Download Files page. The DMR format is an easy to use text file that identifies the location of the change, the element, the old data, and the new data.
For assistance, contact your UPD Account Manager or the Help Desk.
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New CAQH Staff and Career Opportunities
CAQH recently welcomed nine additional staff members, filling new and key positions as the organization continues to grow.
Sheila Bowman has joined CAQH as Manager of Major Accounts, bringing more than 20 years of healthcare and insurance industry experience to the role. Sheila is working with existing and prospective participating organizations to identify opportunities for streamlining administrative processes and assist with utilization of CAQH initiatives. Prior to joining CAQH, Sheila served Humana as an Account Services Executive, where she managed new business, as well as renewals of large commercial accounts with diverse needs. Before joining Humana, Sheila spent more than eight years with one of the nation’s largest healthcare clearinghouses, where she implemented electronic data interchange (EDI) for its clients. Sheila can be reached at sbowman@caqh.org.
Ruth Chigwada has joined CAQH as Billing and Financial Analyst. Her responsibilities include billing, revenue recognition, receivables management and other accounting work to support CAQH operations. Ruth previously worked as Senior Revenue and GL Accountant at FileTek Inc., a software company. She holds an Honors degree in Accounting from the University of Zimbabwe, has successfully completed the CPA exam, and is currently studying to earn an M.B.A. Ruth can be reached at rchigwada@caqh.org.
Andy Fox has joined CAQH as Senior Manager, Business Development. Andy is engaging with existing and prospective participating organizations to consult about CAQH initiatives, help manage provider EFT/ERA enrollments, and support the integration of COB Smart into the healthcare system. He most recently worked with RelayHealth, a McKesson Company, serving as a payer-facing Senior Sales Executive. Andy holds a B.S. from Millersville State University. He can be reached at afox@caqh.org.
Aditi Jariwala has joined the CAQH CORE staff as Associate Director of Education, Outreach, and Partner Relations. Her responsibilities include developing live online CAQH CORE education sessions and cultivating organizational partnerships. Before joining CAQH, Aditi spent eight years as Director of Certification for Surescripts, which operates the nation's largest clinical health information network. In that leadership role, she was responsible for certification of all Surescripts services. Aditi earned an M.B.A. from Georgetown University and a B.S. in computer science and mathematics from Purdue University. She can be reached at ajariwala@caqh.org.
John Lombardi has joined the CAQH CORE staff as Senior Associate of Education, Outreach, and Partner Relations. John coordinates CAQH CORE education sessions and works with organizational partners to engage stakeholders in CAQH CORE activities. John previously worked as a Project Manager for the National Quality Forum and as a Senior Advisor at the Advisory Board Company for its Physician Engagement Initiative. He earned a Bachelor’s degree from George Washington University and a Master’s degree from Marymount University. He can be reached at jlombardi@caqh.org.
Joe Murphy has joined CAQH as Controller. Joe is primarily responsible for preparing monthly financial statements, budgets, and forecasts, in addition to processing payroll. He has more than 20 years of financial experience with previous roles at Pearson, The Washington Post Company and Ernst and Young, among others. He earned a Bachelor’s degree from Georgetown University and is a Certified Public Accountant. Joe can be reached at jmurphy@caqh.org.
Charlie Winters has joined CAQH as Managing Director of Finance and Administration. With more than 25 years of experience in finance, Charlie has helped a range of organizations manage rapid growth and change. His responsibilities include finance, human resources, office services, and information technology. He is a healthcare industry veteran, with 15 years of experience in the industry, as well as five years in public accounting. Charlie earned a B.B.A. from Siena College and is a Certified Public Accountant. He can be reached at cwinters@caqh.org.
Mazen Yacoub has joined the CAQH CORE staff as Senior Manager of Rule-Writing and Certification. Mazen works closely with the CAQH CORE team to facilitate CAQH CORE rule development and manage the CORE Certification program. Prior to joining CAQH, he was a Project Director with the Centers for Medicare & Medicaid Services Office of Enterprise Business. Previously, Mazen held a range of project management and strategic consulting positions, which included six years in the Global Health Services practice at Booz Allen Hamilton. He has a B.A. from Boston College and M.B.A. from Babson College. Mazen can be reached at myacoub@caqh.org.
Jalal Zamanali has joined CAQH as Director of Information Security to oversee the information security program and policies that safeguard CAQH information. Jalal has more than 25 years of experience building innovative, industry-leading technology solutions. He has held IT Security executive positions at notable companies such as IBM, Freddie Mac, Dell, JPMorgan, and Temple Inland. A recognized authority on cyber security, he has chaired several cyber/IT security conferences and forums, and has spoken numerous times at the security conferences around the country. Jalal has served as Chairman of the Institute of Electrical and Electronics Engineers (IEEE) nuclear division for five years. He holds a B.S. in Physics, an M.S. in Nuclear Engineering, and an M.B.A. Jalal can be reached at jzamanali@caqh.org.
CAQH is actively expanding its team to support its increasing portfolio of initiatives. CAQH offers a diverse and innovative work environment with competitive compensation and benefits. Talented individuals committed to achieving the CAQH vision of an efficient healthcare system are encouraged to view and apply to open career opportunities; click here.
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