What is provider credentialing or physician credentialing? Provider credentialing is a regulated process of assessing the qualifications of specific types of providers. This important safety check requires providers such as doctors, dentists, and other allied healthcare professionals to show they have the proper education, training and licenses to care for patients. Hospitals and health plans verify the information supplied by the provider before they are included as an in-network provider. The Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on Accreditation of… Read more »
The term “coordination of benefits” pops up everywhere these days. But hearing it and knowing what it is are two different things. Read on for a little primer, so you can get up to speed on this essential topic of healthcare administration. What is coordination of benefits? There are instances where a person will have more than one insurance plan. For example, a person could have healthcare coverage through their employer but also through their spouse and their spouse’s employer. Those health plans will have to work together to pay claims correctly. That process is called coordination of… Read more »
Platform offers easy access to work group information, resources and events.
In February 2021, CAQH CORE launched a new CAQH CORE Participant Dashboard. This user-friendly platform will simplify how participants can engage with their current work groups and join new ones. It also includes a global calendar of all CAQH CORE events, and enables easy access to all work group documentation, rosters and meeting information. If you are a CAQH CORE participant and did not receive an email with information about how to register, please email email@example.com. A Preview of the CAQH CORE Participant Dashboard
The healthcare industry is facing unprecedented challenges. Medicaid plans, in particular, are navigating significant increases in enrollment and new strains on their time and resources. Your credentialing primary source verification process (PSV) shouldn’t add to your burden. VeriFide™ is seamlessly integrated into CAQH ProView, which is used by more than 1.6 million providers to exchange professional information with payers for commercial, Medicare and Medicaid programs. VeriFide enables users to: Achieve 98.5% PSV file accuracy and completeness through greater automation, diligent… Read more »
This month, CAQH will be sharing tips, tools and resources to help Medicare, Medicaid and commercial plans improve the quality of provider directories. Learn More
2020 CAQH Index: Automating Healthcare Administrative Transactions Has Reduced Annual Costs by $122 Billion, $16.3 Billion More Can Be Saved Through Further Automation
The annual report tracks trends in automation, spending and savings opportunities for healthcare administrative transactions.
CAQH has released the eighth annual report measuring the progress made by healthcare payers and providers in automating administrative transactions. The 2020 CAQH Index found that, of the $372 billion widely cited as the cost of administrative complexity in the US healthcare system, the industry can save $16.3 billion by fully automating nine common transactions. This savings opportunity is on top of the $122 billion in costs the healthcare industry has avoided by streamlining administrative processes. Levels of automation have increased for both the medical and dental industries since the… Read more »
Earlier this year, April Todd spoke to AJMC's Managed Care Cast about the impact of two-day rules on streamlining prior authorization. This became the podcast's most popular episode of 2020. Click here to listen to the podcast.
This month, April Todd presented the new CAQH Endpoint Directory solution at the Office of the National Coordinator for Health Information Technology’s (ONC), Accelerating APIs in Healthcare: A Year in Review and Momentum for 2021 virtual event. CAQH also earned recognition for the collaborative nature of this project. Featuring updates from federal agencies as well as presentations and demos from industry partners that highlight how work underway is advancing innovation in the health IT ecosystem, Accelerating APIs in Healthcare received more than 1,000 attendees. In January, CAQH will… Read more »
Last month, CAQH CORE passed new Operating Rules for patient attribution data exchange and an update to existing connectivity rules: CAQH CORE Value-based Payments Attribution Rules Package Attribution refers to how a patient is assigned to a provider who is then responsible for the quality and cost of his or her care. This process is an essential part of value-based healthcare, in which providers are compensated based on health outcomes of those patients attributed to them. However, providers often find out too late and through inconsistent sources that a patient is attributed to them.… Read more »
For the past decade, the CAQH Index has tracked the adoption of electronic administrative transactions between medical and dental providers and payers. In that time, it has become an authoritative source of information on our nation’s progress toward a more automated and efficient healthcare system. To provide a more complete view of the transition to electronic business processes across healthcare, in 2019 CAQH launched the Pharmacy Services Index, which tracks the adoption of electronic transactions associated with verifying insurance coverage for pharmaceuticals and related services,… Read more »