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March 2018

The U.S. healthcare economy is undergoing a transformation in how care is measured, billed and paid. Organizations around the country are shifting away from fee-for-service models that reimburse providers for the volume of care, and experimenting with value-based payment models, which align quality of care and cost controls with provider compensation. As value-based payment innovation continues, there are many threats to its progress, such as operational challenges.

March 2018

In its second year of adoption, DirectAssure has established itself as a leading solution for health plans to address the ongoing challenge of maintaining accurate provider directories. Making changes to directory information is seamless for healthcare providers, who use CAQH ProView to easily review and update their professional information. DirectAssure participating organizations, including most national plans, are already using the solution to manage directory data for more than 800,000 providers. On average, about 600,000 of those providers review and confirm their information every four months, demonstrating a high level of engagement with CAQH.

March 2018

This May, CAQH is hosting a conference in Washington, DC for health and dental plan managers responsible for provider data, including CAQH ProView administrators. The conference will offer helpful insights for improving provider credentialing, directories and data quality. Attendees will discover how to leverage CAQH Solutions across departments, talk to “power users” about overcoming provider data challenges, preview upcoming enhancements, meet the CAQH Product team, network with peers and more. Contact your CAQH ProView account manager to learn more about this event.

March 2018

In late February, CAQH hosted COB Smart Connection: A Forum for Participating Organizations. The keynote speaker was Jolie H. Matthews, Senior Health and Life Policy Counsel at the National Association of Insurance Commissioners (NAIC). Created in 1871, the NAIC is a nationwide organization that establishes standards to improve the state regulation of insurance, including health and dental.

December 2017

CAQH, a nonprofit alliance of health plans and related associations, recently received the “Excellence in Health IT Award” from the Workgroup for Electronic Data Interchange (WEDI). Presented during the WEDI annual meeting on December 6, the award recognizes organizations and individuals that have made outstanding contributions to the advancement of information technology (HIT) and eCommerce technology in healthcare.

December 2017

Organizations can now become CORE-certified in the Phase IV operating rules for exchanging administrative data electronically. The rules help streamline prior authorization, healthcare claims, employee premium payments, health plan enrollment and disenrollment, and other transactions.

December 2017

CAQH has reduced the number of steps it takes for healthcare providers to enroll in electronic funds transfer (EFT) with payers. Now, in just two clicks—in less than one minute—providers already registered with EnrollHub can sign up to receive electronic payments with additional payers. Previously, providers were required to log into the system, access their account and request enrollment with those payers.

December 2017

Improving provider directory accuracy continues to be an industry-wide challenge. Periodic reviews from the Centers for Medicare and Medicaid Services (CMS) have intensified pressure on health plans to improve the quality of directories. Plans allocate significant resources to these efforts, which are a portion of the $2 billion spent annually by the commercial healthcare industry to maintain provider data.

December 2017

There is widespread consensus that administrative costs in healthcare are excessive. By some estimates, more than $300 billion each year is spent conducting basic business transactions between healthcare providers and health plans. Much of this expense can be attributed to resource-intensive manual processes, such as phone calls to verify patient coverage or mailing claims and paper checks. 

Each year, CAQH collects data from health plans and providers on the shift from manual to electronic business transactions. The findings are compiled in the CAQH Index, the industry source on trends in adoption rates and cost savings associated with automation.

October 2017

In an effort to reduce administrative burdens for all dentists, the ADA and CAQH have formed a strategic alliance to help streamline the credentialing process for dentists, dental plans and employers. The ADA® credentialing service, powered by CAQH ProView®, enables dentists to enter their professional and practice information one time in an easy-to-use, fast and protected digital platform.

ADA is widely promoting this service to all U.S. practicing dentists, including its membership of 161,000 dentists. The number of dentists participating in CAQH ProView is expected to increase substantially, making it the leading industry source for dentists’ credentialing data.

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