October 2020

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 »

October 2020

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 »

October 2020

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 »

October 2020

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.

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October 2020

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.

August 2020

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 CORERead more »

August 2020

CAQH has earned certifications for information security by the Health Information Trust (HITRUST) Alliance for CAQH ProView®, COB Smart®, Read more »

August 2020

As national unemployment rates climb to historic levels, states and payers are experiencing weekly enrollment shifts in Medicaid, ACA marketplaces and employer sponsored insurance. To identify beneficiaries with overlapping health coverage, Medicaid programs need to establish coordination of benefit (COB) strategies that are scalable, accurate and cost effective.

On September 24th, CAQH and the Florida Association of Health Plans will be hosting the Keys to Managing COB in a Crisis, an interactive webinar… Read more »

July 2020

Beginning in July 2000, the founding CAQH members launched a series of initiatives to improve the quality of healthcare and reduce administrative burdens for physicians, patients and payers. These first programs were designed by work groups of health plan and CAQH staff, developing tools and technologies to support physicians and educate patients about vital health issues and insurance benefits.

While today CAQH is focused on streamlining business challenges, some of the early initiatives addressed clinical issues. Here are a few examples:

Health Outcomes.

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