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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July 2020

What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?

In 2000, the healthcare industry was experiencing significant abrasion between providers and payers. In particular, providers were communicating to patients how difficult it was to work with insurers. As a result, consumer sentiment regarding health insurers was at a low point. At the same time, health insurers were fierce competitors and appeared unable to collaborate. Because of those perceptions, two forward thinking CEOs,… Read more »

July 2020

Each year, CAQH publishes a report that tracks the progress the healthcare industry is making toward automating business transactions. For example, the 2019 CAQH Index found that the medical and dental industry could save an additional $13.3 billion dollars annually by automating administrative transactions.

This research is made possible through the voluntary participation of stakeholders from across healthcare.

Data collection is underway for this year’s… Read more »

July 2020

For the fifth consecutive year, CAQH, an industry alliance working to streamline the business of healthcare, has been named one of the “Best Places to Work” by Modern Healthcare.

“As we celebrate the 20th anniversary of CAQH, we know that we would not have been able to achieve as much without a team of innovative, mission-driven professionals dedicated to addressing healthcare’s biggest business challenges,” said Robin Thomashauer, President of CAQH. “While it is an honor to receive this recognition from Modern Healthcare, it is an even greater honor to work every day with such an… Read more »

July 2020

CAQH CORE will be playing an active role in this year’s WEDI Forum, and leading two sessions during the three-day event:

  • Wednesday, August 5th, from 11:30 am - 12:00 pm ET - The CAQH CORE team will be conducting an interactive presentation about the value of earning a CAQH CORE Certification.
  • Thursday, August 6th, from 12:30 - 1:15 pm ET - CAQH CORE Director, Robert Bowman, will give a CAQH CORE update, including recent rule development activities on prior… Read more »
June 2020

SSI Group and Availity, two leading revenue cycle management companies, are the latest organizations to achieve new CAQH CORE Certifications. Both are now CAQH CORE-certified for Prior Authorization & Referrals (infrastructure). Availity also achieved certification for Health Care Claims. Previously, both SSI and Availity were CAQH CORE-certified for Eligibility & Benefits, Claim Status and Payment & Remittance.

CAQH CORE Certification is a voluntary program that recognizes entities that… Read more »