June 2021
In a recent study, CAQH found that inefficient COB processes cost the healthcare industry more than $800 million annually. The bulk of these costs are incurred because health plans often do not have access to high-quality data about other overlapping coverage before claims are paid. A successful COB program increases efficiency, prevents incorrect payments, and provides a better experience for providers and members, but it requires trustworthy data about coverage overlaps. Many vendors claim to have this data, but the quality varies. The success of a plan’s COB program hinges on having… Read more »
May 2021
There are a lot of reasons to start a payment integrity program: potential cost savings, operational efficiency, a taste for innovation. For Chad Roswick, senior director of Enterprise Shared Services at L.A. Care, a health plan serving the most vulnerable residents of Los Angeles County, the reason was financial stewardship. The health plan has a large Medi-Cal membership, and Chad wanted to make sure that they were properly administering state and federal funds and reducing expenses when possible. Regardless of your reason for looking into payment integrity, Chad’s journey provides a… Read more »
May 2021
What Is a Provider Directory? Simply put, a provider directory is a list of physicians in an area and within an insurance plan. People use that information when they need care to find a local doctor that takes their insurance and is also accepting new patients, so the information needs to be accurate. Health plans also create directories to help members decide which insurance product to sign up for during open enrollment periods, so members can ensure that their preferred doctors accept the plan they choose. The information in health plan provider directories is often inaccurate, with… Read more »
April 2021
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 »
March 2021
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.

February 2021
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 core@caqh.org.   ​ A Preview of the CAQH CORE Participant Dashboard  
February 2021
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 »
February 2021
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

The annual report tracks trends in automation, spending and savings opportunities for healthcare administrative transactions. 

February 2021
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 »
January 2021
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.