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June 2017

CAQH has convened a cross-section of healthcare leaders to improve the accuracy of provider data for both industry stakeholders and patients. The Provider Data Action Alliance will develop a roadmap that articulates a vision and actionable strategies for obtaining and sharing better information. Alliance participants represent health, dental and vision plans; provider organizations; health systems; government; and health information exchanges.

The Alliance was a result of the 2016 Provider Data Summit, a CAQH-hosted conference where more than 100 industry leaders met to discuss provider data challenges. Attendees reached agreement on the priorities for improving provider data and called for further industry-wide collaboration. Summit discussions were informed by a white paper created by CAQH with support from Manatt Health, a leading health policy and research firm.

June 2017

The newly available 2016 CAQH Annual Report outlines the many accomplishments of the organization that support its mission of streamlining the business of healthcare. For those who may only know CAQH through experiences with a specific solution or initiative, the report provides the opportunity to learn more about the full breadth of CAQH activities.

June 2017

For the second year in a row, CAQH has been named by Modern Healthcare as one of the Best Places to Work in Healthcare for 2017. The program recognizes 100 organizations and companies nation-wide for the ability to “empower their employees to provide patients and customers with the best possible care, products and services.”

June 2017

Boston Medical Center Health Plan, Providence Health Plan and UPMC Health Plan have completed testing and been awarded CORE certifications for Phases I-III of the CAQH CORE Operating Rules. Organizations in this rapidly growing part of the new healthcare economy are seeking CORE Certification to go above and beyond regulatory requirements and improve electronic data sharing.

According to a report by McKinsey & Company, today more than 15 million people are covered by provider-owned insurance plans in 39 states, and that number is growing. These plans combine both medical claims and clinical data enabling them to achieve economies of scale, manage risk and improve population health.

CORE Certification supports these goals by ensuring they exchange administrative data securely, accurately and efficiently.

June 2017

CAQH Deputy Director and CAQH CORE Managing Director Gwendolyn Lohse has been named by Health Data Management as one of the 2017 Most Powerful Women in Healthcare IT, in the thought leader category. The award recognizes women in the field of healthcare IT who have made valuable contributions to advancing the industry.

Lohse has been with CAQH since its inception. She played an instrumental role in bringing the important concept of operating rules to the healthcare industry and in creating CAQH CORE, the Committee on Operating Rules for Information Exchange, the industry-wide alliance that led to their development and wide-spread adoption. More than 130 organizations – including health plans, hospitals and health systems and IT vendors – have joined CAQH CORE.

April 2017

CAQH has developed a groundbreaking solution that reduces the burden – for both health plans and providers – of authenticating the accuracy and completeness of provider information to support credentialing decisions. 

VeriFide™, the provider credential verification solution from CAQH, delivers rapid, high quality data to plans through advanced technologies, economies of scale and – over the next few years – industry-wide alignment of provider credentialing dates. The organization’s goal is to reducing the overlapping, non-differentiating business processes associated with credentialing.

April 2017

One year after its launch, DirectAssure has become an important resource to help health and dental plans improve the quality of their provider directories. More than 500,000 healthcare providers have reviewed, updated and confirmed their professional information for use in directories, and more than 30 health and dental plans are already participating in this industry-wide solution.

April 2017

CAQH CORE announced that it has awarded more than 300 CORE Certifications to health plans, hospitals and health systems, clearinghouses and vendors with recent Aetna and Cigna awards. The continued increase in the number of organizations seeking and receiving certification underscores the value they place on demonstrating that they meet – and exceed – the CORE operating rules and underlying standards for electronic business transactions.  

April 2017

CAQH efforts to convene the industry to solve provider data challenges were discussed in a recent article in AIS Health Plan Week. The article explored the problem from different stakeholder perspectives amid a changing healthcare environment and increased regulations for directory maintenance.

The healthcare industry spends a collective $2.1 billion on inefficient processes maintaining provider data, two-thirds of which are health plan expenses. The lack of trusted sources of information have led to the proliferation of highly-individualized databases and tools, which have, over time, increased costs and increased the administrative burden for both health plans and healthcare providers.

April 2017

Are we doing all we can to maximize administrative savings in healthcare? What are the biggest opportunities to cut costs for healthcare providers, health plans and other industry stakeholders? On Feb. 16, CAQH (@CAQH) held a Twitter chat with Health Populi blogger Jane Sarasohn-Kahn (@healthythinker) to discuss the topic.

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