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September 2019

In response to a request for information (RFI) from HHS and CMS, CAQH CORE submitted comments on “Reducing Administrative Burden to Put Patients over Paperwork,” an initiative to focus the healthcare delivery system on patient-centered care, innovation and outcomes.

In the response, CAQH addressed:

September 2019

For health plans, coordinating benefits is challenging under the best of circumstances. Due to the complexity of payment systems, and a lack of data uniformity, interoperability and transparency, most plans rely on recovery vendors to identify third-party liability after claims are paid. It is a highly manual and inefficient system that results in overpayments going uncollected and significant increases in costs and labor efforts.

September 2019

This summer, CAQH spoke to members of the NCSL Insurance Task Force on initiatives to streamline the business of healthcare and improve provider data.

In August, CAQH Director of State Relations, Randi Chapman, addressed the task force at the NCSL summit, which was attended by legislators from across the country, AHIP, BCBSA, the American Dental Association and other industry groups.

Industry momentum increases as additional provider groups participate and a leading third party vendor integrates Groups-compatible rosters

July 2019

Webinar: Improving the Delegated Roster Process

Health plans and delegated provider groups are invited to an August 14 webinar to hear from industry peers who are using CAQH ProView for Groups to share delegated data. Presenters from a regional health plan and delegated group will explain how the solution is changing their approach to delegated data and best practices for implementing a similar process. Learn more or register here.

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:

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