January 2021
Earlier this year, April Todd spoke to AJMC's Managed Care Cast about the impact of two-day rules on streamlining prior authorization. This became the podcast's most popular episode of 2020.  Click here to listen to the podcast. 
January 2021
This month, April Todd presented the new CAQH Endpoint Directory solution at the Office of the National Coordinator for Health Information Technology’s (ONC), Accelerating APIs in Healthcare: A Year in Review and Momentum for 2021 virtual event. CAQH also earned recognition for the collaborative nature of this project. Featuring updates from federal agencies as well as presentations and demos from industry partners that highlight how work underway is advancing innovation in the health IT ecosystem, Accelerating APIs in Healthcare received more than 1,000 attendees. In January, CAQH will… Read more »
January 2021
Last month, CAQH CORE passed new Operating Rules for patient attribution data exchange and an update to existing connectivity rules: CAQH CORE Value-based Payments Attribution Rules Package Attribution refers to how a patient is assigned to a provider who is then responsible for the quality and cost of his or her care. This process is an essential part of value-based healthcare, in which providers are compensated based on health outcomes of those patients attributed to them. However, providers often find out too late and through inconsistent sources that a patient is attributed to them.… Read more »
January 2021
For the past decade, the CAQH Index has tracked the adoption of electronic administrative transactions between medical and dental providers and payers. In that time, it has become an authoritative source of information on our nation’s progress toward a more automated and efficient healthcare system. To provide a more complete view of the transition to electronic business processes across healthcare, in 2019 CAQH launched the Pharmacy Services Index, which tracks the adoption of electronic transactions associated with verifying insurance coverage for pharmaceuticals and related services,… Read more »
November 2020
For more than a decade the healthcare industry has been guided by the triple aim: the goal to deliver an improved patient experience, at lower costs, while improving the overall health of a population. But as providers are expected to deliver more value and take on more financial risk, a fourth aim has been added — avoiding physician burnout. A 2019 national survey reported that over 44 percent of physicians experience some type of burnout. Of these physicians, 59 percent identified administrative tasks as the number one contributor. The exchange of medical documentation, i.e., attachments… Read more »
November 2020
The credentialing process can be cumbersome for both healthcare providers and health plans. Over the years, solutions have been developed to alleviate the burdens associated with this workflow. But, while advances have been made in automating credentialing, a new problem has emerged: plans and providers are using a multiplicity of platforms that do not communicate with one another. Now, a physician who contracts with 10 or more plans may use just as many portals, platforms and manual processes to provide credentialing information to each. In short, the benefits of automation are being lost… Read more »
November 2020
This month, April Todd, Senior Vice President CORE and Explorations, was invited to speak about prior authorizations on the Change Healthcare. Among other topics, April shed light on areas around prior authorization that remain the most challenging, the benefits of transitioning to an automated workflow and efforts underway to speed adoption of electronic processes. She also discussed the impact that COVID-19 is having on adoption. To listen to the full episode, click here. 
October 2020
CAQH has announced the development of a centralized directory of validated payer FHIR endpoints and third-party applications. This solution will simplify how healthcare organizations and app developers connect with each other to help consumers access and transfer their healthcare information. The directory, developed with support from the technology company Edifecs, will help payers meet new Centers for Medicare and Medicaid Services (CMS) interoperability regulations that become effective in 2021 and 2022. Earlier this year, CMS released a final Interoperability and Patient Access rule… Read more »
October 2020
The National Association of Insurance Commissioners (NAIC)’s Center for Insurance Policy and Research (CIPR) has released the final installment of its comprehensive study, “Rising Health Care Costs: Drivers, Challenges and Solutions.” A compilation of individually authored papers, this report brings together healthcare thought leaders, researchers and practitioners to provide a wide spectrum of viewpoints on the rising cost of care. CAQH contributed two papers to this report that examined cost savings opportunities through administrative workflows and alternative payment models. “… Read more »
October 2020
WEDI has announced that CAQH and CAQH CORE will be leading two sessions at the organization’s upcoming National Conference: The CAQH CORE Attachments Update (10/16 from 12:45-1:30 ET). During this interactive session, Robert Bowman, Director, CORE, will provide an update on CAQH CORE operating rule development related to attachments and the electronic exchange of additional medical documentation to support prior authorization and claims. To learn more about CAQH CORE Attachment Initiatives, click here. CAQH Endpoint Directory Overview & Demo (10/21 from 3:00-3:45 ET). CAQH will provide… Read more »