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Paper highlights barriers to automation and a roadmap to a streamlined electronic process

July 2019

CAQH CORE has released a new white paper on automating prior authorization. The paper identifies six barriers to automation:

July 2019

The National Committee for Quality Assurance (NCQA) recently completed a review of CAQH ProView, DirectAssure, and CAQH ProView for Groups. In a letter to CAQH, NCQA states, “In addition to increasing efficiency in credentialing and network operations, these solutions are beneficial to NCQA customers in supporting accreditation.”

Plans across the state align efforts to improve provider data

June 2019

Texas is the latest state where leading health plans are adopting CAQH ProView to improve the accuracy of provider data. Participating organizations include Amerigroup, Superior HealthPlan and UnitedHealthcare, whose combined membership represents nearly 4 million Texans and more than 50 percent of the Medicaid covered population.

Machine learning is improving provider data quality 

June 2019

CAQH led a discussion on “Artificial Intelligence and the Future of Data Quality” at AHIP Institute & Expo 2019 in Nashville. In the session, Hassaan Sohail, Manager, Product Innovation at CAQH, explained how the organization is using AI to improve the accuracy of health plan directories.

Survey closes July 15, 2019

June 2019

CAQH is collecting voluntary data contributions for the 2019 CAQH Index, an annual industry-wide effort that tracks healthcare industry progress from manual to electronic business processes for common administrative transactions. In exchange for participation, contributors will receive a personalized benchmark report that measures the performance of their organization against industry standards in key areas. Data contribution typically takes only a few hours.

Registration is open now 

June 2019

This summer, CAQH CORE is hosting interactive webinars on several trending topics in healthcare, including:

Health plan professionals gather to discuss provider data and other pressing topics 

June 2019

The 2019 CAQH ProView Symposium was held last month in Washington, DC. The event, titled “Achieving Provider Data Excellence,” was attended by representatives from nearly 50 health plans across the nation.

New rules aim to improve prior authorization process

May 2019

Today, 88 percent of prior authorizations are conducted either partially or entirely manually. CAQH CORE has released the Phase V Operating Rules to strengthen the accuracy and trustworthiness of the prior authorization process and move the industry toward full automation.

Be part of the leading industry source for tracking health plan and provider adoption of fully electronic administrative transactions.

May 2019

Recently, the 2018 CAQH Index study revealed that the healthcare industry could save $12.4 billion by transitioning from manual to electronic processes. These critical findings are made possible by voluntary participation from providers and health plans who help to offer a comprehensive view of common business processes across the industry.

CAQH CORE releases new white paper

May 2019

The healthcare industry has made significant progress in adopting electronic transactions for common business practices. However, the lack of a standard for attachments has contributed to cumbersome processes for exchanging patient-specific medical information and supplemental documentation.

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