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.
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… Read more »
This month, April Todd, Senior Vice President CORE and Explorations, was invited to speak about prior authorizations on the Change Healthcare.
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… Read more »
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… Read more »
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… Read more »
In August, CAQH CORE hosted a webinar to share initial findings of the Prior Authorization Pilot & Measurement Initiative, which works with industry organizations to measure the impact of standards and operating rules on efficiency metrics and staff experience. The case study webinar with Cleveland Clinic and PriorAuthNow, the first in a series, highlighted the impact that prior authorization (PA) automation and workflow integration may have on the health system.
To mark the 20th anniversary of CAQH, this year’s annual report tells the story of the organization’s founding, provides highlights from initiatives over the years, and outlines its vision to transform the business of healthcare in the future.
Click here to read the 2019 CAQH annual report.
Health insurers use prior authorization as a check on the safety, quality, necessity and cost of medical services. When done manually, this process can be confusing, labor-intensive and expensive for the provider and payer teams that manage it. This can create delays to patient care, and frustrations across the industry.
This month, CAQH CORE… Read more »