November 2020
For more than a decade the healthcare industry has been guided by the triple aim: the goal to deliver an improved patient experience, at lower costs, while improving the overall health of a population. But as providers are expected to deliver more value and take on more financial risk, a fourth aim has been added — avoiding physician burnout. A 2019 national survey reported that over 44 percent of physicians experience some type of burnout. Of these physicians, 59 percent identified administrative tasks as the number one contributor. The exchange of medical documentation, i.e., attachments… Read more »
November 2020
The credentialing process can be cumbersome for both healthcare providers and health plans. Over the years, solutions have been developed to alleviate the burdens associated with this workflow. But, while advances have been made in automating credentialing, a new problem has emerged: plans and providers are using a multiplicity of platforms that do not communicate with one another. Now, a physician who contracts with 10 or more plans may use just as many portals, platforms and manual processes to provide credentialing information to each. In short, the benefits of automation are being lost… Read more »
November 2020
This month, April Todd, Senior Vice President CORE and Explorations, was invited to speak about prior authorizations on the Change Healthcare. Among other topics, April shed light on areas around prior authorization that remain the most challenging, the benefits of transitioning to an automated workflow and efforts underway to speed adoption of electronic processes. She also discussed the impact that COVID-19 is having on adoption. To listen to the full episode, click here. 
October 2020
CAQH has announced the development of a centralized directory of validated payer FHIR endpoints and third-party applications. This solution will simplify how healthcare organizations and app developers connect with each other to help consumers access and transfer their healthcare information. The directory, developed with support from the technology company Edifecs, will help payers meet new Centers for Medicare and Medicaid Services (CMS) interoperability regulations that become effective in 2021 and 2022. Earlier this year, CMS released a final Interoperability and Patient Access rule… Read more »
October 2020
The National Association of Insurance Commissioners (NAIC)’s Center for Insurance Policy and Research (CIPR) has released the final installment of its comprehensive study, “Rising Health Care Costs: Drivers, Challenges and Solutions.” A compilation of individually authored papers, this report brings together healthcare thought leaders, researchers and practitioners to provide a wide spectrum of viewpoints on the rising cost of care. CAQH contributed two papers to this report that examined cost savings opportunities through administrative workflows and alternative payment models. “… Read more »
October 2020
WEDI has announced that CAQH and CAQH CORE will be leading two sessions at the organization’s upcoming National Conference: The CAQH CORE Attachments Update (10/16 from 12:45-1:30 ET). During this interactive session, Robert Bowman, Director, CORE, will provide an update on CAQH CORE operating rule development related to attachments and the electronic exchange of additional medical documentation to support prior authorization and claims. To learn more about CAQH CORE Attachment Initiatives, click here. CAQH Endpoint Directory Overview & Demo (10/21 from 3:00-3:45 ET). CAQH will provide… Read more »
October 2020
In August, CAQH CORE hosted a webinar to share initial findings of the Prior Authorization Pilot & Measurement Initiative, which works with industry organizations to measure the impact of standards and operating rules on efficiency metrics and staff experience. The case study webinar with Cleveland Clinic and PriorAuthNow, the first in a series, highlighted the impact that prior authorization (PA) automation and workflow integration may have on the health system. Attendees learned how the implementation of a PA solution leveraging the standard transaction and CAQH CORE PA operating… Read more »
October 2020
To mark the 20th anniversary of CAQH, this year’s annual report tells the story of the organization’s founding, provides highlights from initiatives over the years, and outlines its vision to transform the business of healthcare in the future. Click here to read the 2019 CAQH annual report.
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 CORE proposed three Prior Authorization & Connectivity Operating Rules to accelerate automation of the prior authorization process at a hearing with the National Committee on Vital and Health Statistics (NCVHS), an advisory committee to the Secretary of… Read more »
August 2020
CAQH has earned certifications for information security by the Health Information Trust (HITRUST) Alliance for CAQH ProView®, COB Smart®, EnrollHub®, DirectAssure®, VeriFide™ and SanctionsTrack®. With the HITRUST CSF Certified Status, these products have been proven to meet important regulations and requirements for protecting and securing sensitive private healthcare information. This achievement places CAQH in an elite group of organizations worldwide that have earned this certification. The HITRUST CSF is a thorough evaluation that includes federal and state regulations, standards and… Read more »