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September 2018

Last month, the CAQH CORE Board submitted an open letter in support of the Consensus Statement on Improving the Prior Authorization Process, which shares many CAQH CORE goals, such as improved transparency and communications, continuity of patient care and automation and efficiency.

Committed to collaborating with industry stakeholders, CAQH CORE is eager to work with the statement’s authoring organizations, which include the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA).

The 2017 CAQH Index found that healthcare provider and health plan adoption of standard prior authorization transactions was only eight percent--one of the lowest adoption rates of all transactions measured in the report. The proportion of prior authorization transactions conducted using that standard actually declined by more than 10 percentage points in comparison to the 2016 CAQH Index. However, automating prior authorization could result in savings of $6.84 per transaction.

September 2018

The ongoing need to reduce administrative expenses in healthcare—while concurrently increasing information accuracy—is at the heart of CAQH activities that benefit the healthcare providers, health plans and agencies that serve Medicaid patients.

September 2018

HealthCare Administrative Solutions (HCAS), a non-profit organization of Massachusetts-based health plans, has chosen DirectAssure® after an extensive search for a solution to improve healthcare provider directories in the state.

With DirectAssure, providers enter their directory information changes once and share them with multiple plans. The solution works in concert with CAQH ProView®, an online database used by more than 1.4 million providers nationwide to maintain their professional and practice information. DirectAssure asks providers to compare and verify practice location information within health plan records and confirm whether they accept specific insurance plans and if they are accepting new patients.

July 2018

The healthcare industry has made moderate progress in the adoption of electronic business transactions, but significant savings potential remains for healthcare providers and health plans, according to the 2017 CAQH Index released on June 14th. The fifth annual CAQH Index measures adoption, costs and provider labor time associated with the most common administrative transactions conducted between health plans and providers.

July 2018

CAQH has achieved Certified status for information security by the Health Information Trust (HITRUST) Alliance. The HITRUST certification validates that CAQH meets key healthcare regulations and requirements for protecting and securing sensitive private healthcare information. The certification applies to CAQH infrastructure, security and privacy programs and the entire portfolio of CAQH Solutions (CAQH ProView, DirectAssure, VeriFide, EnrollHub, SanctionsTrack and COB Smart).

July 2018

CAQH is pleased to announce that our work to simplify the business of healthcare is having an increasing impact. As we hire more staff to meet new demands for our growing portfolio of solutions, we have outgrown our current office space.

CAQH is moving its physical address in Washington, DC, in August. CAQH will be relocating to:

2020 K Street, NW
Suite 900
Washington, DC 20006

May 2018

The Provider Data Action Alliance (PDAA), a diverse group of 20 healthcare leaders convened by CAQH, has released a roadmap outlining recommendations to address provider data issues impacting healthcare providers, patients and health plans. The industry spends $2 billion annually to maintain provider data, yet errors and inefficiencies remain, disrupting many crucial processes in the healthcare system.

An Industry Roadmap for Provider Data” outlines a core set of principles that can guide the development of an industry solution, a model for what the provider data system should look like and a plan to implement the vision and ensure industry support.

May 2018

Modern Healthcare Best Places Award 2018

Modern Healthcare recognized CAQH on its list of the Best Places to Work in Healthcare for 2018. This is the third year in a row that CAQH has been included on the list of 150 organizations and companies across the U.S. that “stand out in their efforts to create an empowered and satisfied workforce.”

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.

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