Newsletter Home Listing

August 2017

There has long been an industry imperative to improve the quality of information in health plan provider directories. Over the last two years, new federal and state regulations have added pressure, requiring strategies that prioritize error removal and strengthen provider engagement.

Federal regulations now require Medicare Advantage, Medicaid and Qualified Health Plans to conduct routine provider outreach or submit more frequent updates that can include monthly reporting. Plans can be subject to financial penalties if found uncompliant.

August 2017

To learn more about how DirectAssure is improving provider directory data, view a recent webinar that includes a case study by UnitedHealthcare, a DirectAssure participating plan, or contact sales@caqh.org.

August 2017

CAQH ProView was launched on a new platform in 2015 to enable greater flexibility and growth for the solution. CAQH has been working since the launch to improve the accuracy of the data within the platform, and expand its use in addressing additional, industry-wide provider data needs.

Ongoing system improvements contribute to a timely and accurate exchange of data between providers and health plans. In most cases, CAQH ProView is requesting new information from providers that health plans previously secured through phone outreach, requiring practices to field calls and deliver responses to multiple plans. In other cases, more precise information addresses patients’ need for improved provider directories.

August 2017

A new article in Group Practice Journal describes how providers can take greater advantage of the progress made by the CAQH CORE Operating Rules and Certification Program. Written by Susan L. Turney, M.D., CEO of Marshfield Clinic Health System and Vice-Chair of the CAQH CORE Board, the article emphasizes the importance of the work by CAQH CORE to streamline electronic business transactions and the need for greater industry participation in the certification program.

Turney describes how most providers should now have all of their payers—both public and private—conducting real-time processing of eligibility and benefits verification and claim status inquiries. Payers should also be offering the option to electronically receive payments, among other efficiencies in common business transactions due to CAQH CORE initiatives.

August 2017

The 2016 CAQH Index findings were displayed during a Technology and Health poster session at the Academy Health Annual Research Meeting in June. The poster session was part of a three-day annual meeting where more than 2,500 attendees gathered to learn about the latest health services research improving health and healthcare around the globe.

The CAQH Index poster highlighted industry efforts to increase automation of routine healthcare administrative transactions. The 2016 report found that there is more than $11 billion in savings available to medical and dental health plans and providers with greater adoption of electronic transactions.

June 2017

CAQH has convened a cross-section of healthcare leaders to improve the accuracy of provider data for both industry stakeholders and patients. The Provider Data Action Alliance will develop a roadmap that articulates a vision and actionable strategies for obtaining and sharing better information. Alliance participants represent health, dental and vision plans; provider organizations; health systems; government; and health information exchanges.

The Alliance was a result of the 2016 Provider Data Summit, a CAQH-hosted conference where more than 100 industry leaders met to discuss provider data challenges. Attendees reached agreement on the priorities for improving provider data and called for further industry-wide collaboration. Summit discussions were informed by a white paper created by CAQH with support from Manatt Health, a leading health policy and research firm.

June 2017

The newly available 2016 CAQH Annual Report outlines the many accomplishments of the organization that support its mission of streamlining the business of healthcare. For those who may only know CAQH through experiences with a specific solution or initiative, the report provides the opportunity to learn more about the full breadth of CAQH activities.

June 2017

For the second year in a row, CAQH has been named by Modern Healthcare as one of the Best Places to Work in Healthcare for 2017. The program recognizes 100 organizations and companies nation-wide for the ability to “empower their employees to provide patients and customers with the best possible care, products and services.”

June 2017

Boston Medical Center Health Plan, Providence Health Plan and UPMC Health Plan have completed testing and been awarded CORE certifications for Phases I-III of the CAQH CORE Operating Rules. Organizations in this rapidly growing part of the new healthcare economy are seeking CORE Certification to go above and beyond regulatory requirements and improve electronic data sharing.

According to a report by McKinsey & Company, today more than 15 million people are covered by provider-owned insurance plans in 39 states, and that number is growing. These plans combine both medical claims and clinical data enabling them to achieve economies of scale, manage risk and improve population health.

CORE Certification supports these goals by ensuring they exchange administrative data securely, accurately and efficiently.

June 2017

CAQH Deputy Director and CAQH CORE Managing Director Gwendolyn Lohse has been named by Health Data Management as one of the 2017 Most Powerful Women in Healthcare IT, in the thought leader category. The award recognizes women in the field of healthcare IT who have made valuable contributions to advancing the industry.

Lohse has been with CAQH since its inception. She played an instrumental role in bringing the important concept of operating rules to the healthcare industry and in creating CAQH CORE, the Committee on Operating Rules for Information Exchange, the industry-wide alliance that led to their development and wide-spread adoption. More than 130 organizations – including health plans, hospitals and health systems and IT vendors – have joined CAQH CORE.

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