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. 
January 2021
This month, April Todd presented the new CAQH Endpoint Directory solution at the Office of the National Coordinator for Health Information Technology’s (ONC), Accelerating APIs in Healthcare: A Year in Review and Momentum for 2021 virtual event. CAQH also earned recognition for the collaborative nature of this project. Featuring updates from federal agencies as well as presentations and demos from industry partners that highlight how work underway is advancing innovation in the health IT ecosystem, Accelerating APIs in Healthcare received more than 1,000 attendees. In January, CAQH will… Read more »
January 2021
Last month, CAQH CORE passed new Operating Rules for patient attribution data exchange and an update to existing connectivity rules: CAQH CORE Value-based Payments Attribution Rules Package Attribution refers to how a patient is assigned to a provider who is then responsible for the quality and cost of his or her care. This process is an essential part of value-based healthcare, in which providers are compensated based on health outcomes of those patients attributed to them. However, providers often find out too late and through inconsistent sources that a patient is attributed to them.… Read more »
January 2021
For the past decade, the CAQH Index has tracked the adoption of electronic administrative transactions between medical and dental providers and payers. In that time, it has become an authoritative source of information on our nation’s progress toward a more automated and efficient healthcare system. To provide a more complete view of the transition to electronic business processes across healthcare, in 2019 CAQH launched the Pharmacy Services Index, which tracks the adoption of electronic transactions associated with verifying insurance coverage for pharmaceuticals and related services,… Read more »
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.