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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.

Integrated portal creates seamless transition between two CAQH Solutions

May 2019

CAQH continues to make progress in improving provider directory data. Most recently, CAQH launched a new portal that streamlines access to provider directory data by integrating DirectAssure and CAQH ProView.

May 2019

Late last year, CAQH launched CAQH ProView for Groups to simplify the way data is shared between delegated provider groups and health plans. This first-of-its-kind functionality replaces the highly manual processes widely used today with an intuitive, efficient module within CAQH ProView.

March 2019

Artificial Intelligence developed by CAQH is now making it possible to increase the accuracy of healthcare provider directories, without contacting the provider.

March 2019

In a recent milestone for the healthcare system, industry-leading providers, Medicaid programs, health plans, clearinghouses, and product vendors have achieved more than 350 CORE Certifications. Each certification demonstrates a healthcare organization’s commitment to ensuring business transactions flow seamlessly.

Reducing Administrative Costs in Healthcare

March 2019

CAQH recently submitted a letter to the Senate Committee on Health, Education, Labor and Pensions (“HELP Committee”) with recommendations to reduce administrative costs in healthcare. In response to a

March 2019

Of the many business transactions measured in the 2018 CAQH Index, claims status inquiries offer the healthcare system the greatest per-transaction opportunity for cost savings. Despite fewer claim status inquiries occurring overall compared to the prior year, a significant savings opportunity remains because the transaction is highly inefficient when not conducted electronically.

MD-Staff Generating CAQH ProView for Groups-compatible Rosters

February 2019

The traditional model of sharing data between delegated healthcare provider groups and health plans is complex for all parties. Plans frequently receive delegated group information in varying formats and at different times. Delegated groups must maintain unique rosters and change reports for each plan, and typically do not know when plans process their data.

February 2019

Challenges related to coordination of benefits (COB) are a financial drain for health plans and a headache for providers. Claim payments are often made in error or delayed due to complicated manual processes, as well as a lack of clarity on which plan should be the primary payer.

February 2019

Prior authorization (PA) is a common source of frustration in healthcare. According to a recent survey from the American Medical Association, 28 percent of providers reported that the PA process has affected care delivery and led to a serious adverse event. Notably, 88 percent said the burden associated with prior authorization has increased over the last five years for their practice.

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