November 2022
As the current and immediate past Chairs of the CAQH CORE Board, we are excited to discuss the operating rule package currently under consideration for federal mandate. Below we will review the path to federal mandate, the proposed rules, and what to expect next. CAQH CORE is designated by the Secretary of the Department of Health and Human Services (HHS) as the Operating Rule Authoring Entity for the HIPAA-mandated administrative transactions. When the CORE Board approves new and updated operating rules as the final step in the formal CAQH CORE Voting Process, we discuss whether to submit… Read more »
September 2022
Value-based payment (VBP) models pay providers based on the outcomes of the care they deliver, not the volume. VBP models are recognized for their potential to lower costs, increase quality, and promote equity. Almost 60% of healthcare payments are tied to some form of value, be it through pay-for-performance incentives - such as payment add-ons for controlling chronic conditions in a patient population - or shared-risk arrangements between providers and payers, like population-health models that measure performance against a total cost of care benchmark. The penetration of VBP contracts in… Read more »
July 2022
On May 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Interoperability and Patient Access final rule, with the goal of giving patients better access to their health information. Great progress has been made since the rule was enacted. Today more than two-thirds of payers have made Patient Access APIs available.  However, health plans still face challenges and barriers with FHIR adoption and must address those obstacles to keep progressing and ensure high priority interoperability needs are met. To gain a better understanding of implementation approaches and… Read more »
June 2022
CAQH CORE has announced five new Board members to help advance CORE’s mission to drive the creation and adoption of healthcare operating rules, accelerate interoperability and align administrative and clinical activities. Please join CAQH CORE in welcoming: Anika Gardenhire, RN, CHCIO, Chief Digital Officer, Centene Corporation Anika is a healthcare strategy and technology executive with deep experience assisting clinicians, operations teams and information technology professionals in utilizing information systems to ensure excellent patient and member care. Before joining Centene in 2020… Read more »
March 2022
Patients rely on a variety of sources to find the care they need from the clinicians they prefer. These include search engines, doctor rating sites and referrals. Among the more common resources that patients use are health plan provider directories which, according to two surveys conducted in 2020, more than half of patients use to select a physician. Despite industry efforts, the accuracy of health plan provider directories is a persistent challenge. Recently, the American Medical Association and CAQH released a white paper analyzing the current state of the provider directory problem,… Read more »
March 2022
According to a recent CAQH ProView® provider data analysis, dentists who share their professional and practice information with multiple plans using a single platform are far more likely to keep their information updated than those who use multiple methods. Specifically, almost 90 percent of dentists who use ProView to share provider data with 10 or more dental plans, keep their profile current — meaning they attest to the accuracy of their self-reported data every four months. Why? Because a single platform for credentialing, adopted by both dental plans and dentists, offers a solution to… Read more »
March 2022
Automated credentialing, a process in which a provider completes a plan enrollment application electronically, has seen slower adoption in the dental industry. Today, many dental practices are still completing paper-based credentialing applications and submitting them to plans via email or fax. Since automated credentialing can reduce administrative costs for both dental practices and plans, and is widely adopted by physicians and the medical community, why has the dental industry lagged? Dental plans may provide both electronic and paper-based enrollment application options to accommodate… Read more »
February 2022
Dental provider credentialing, a process most often associated with a dentist contracting with an insurance carrier, can be cumbersome for both dentists and dental plans. One reason is related to slow adoption of automated solutions resulting in continued reliance on paper-based submissions of enrollment applications. Even when automated solutions are used, a dentist may need to access a separate platform to complete the enrollment application for each contracted plan. Numerous contractual and regulatory requirements obligate dental plans to ensure that contracted dentists are legally… Read more »
February 2022
CAQH has released the ninth annual report measuring the progress healthcare payers and providers are making to use electronic business processes. Every year, the CAQH Index tracks automation, spending and savings opportunities for administrative transactions related to verifying insurance coverage and cost sharing, obtaining authorization for care, submitting claims and supplemental information, and sending and receiving payments. The report categorizes transactions by whether they are fully automated, partially electronic or manual. This year’s Index considers the impact of the pandemic on… Read more »
January 2022
The No Surprises Act of 2021 takes another step toward mandating that health plans improve the accuracy of their provider directories. The Act includes specific requirements health plans must meet by January 2022. Are you ready? Download the brief to learn more, and request a demonstration today. See a Demo