July 2020

What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?

In 2000, the healthcare industry was experiencing significant abrasion between providers and payers. In particular, providers were communicating to patients how difficult it was to work with insurers. As a result, consumer sentiment regarding health insurers was at a low point. At the same time, health insurers were fierce competitors and appeared unable to collaborate. Because of those perceptions, two forward thinking CEOs,… Read more »

July 2020

Each year, CAQH publishes a report that tracks the progress the healthcare industry is making toward automating business transactions. For example, the 2019 CAQH Index found that the medical and dental industry could save an additional $13.3 billion dollars annually by automating administrative transactions.

This research is made possible through the voluntary participation of stakeholders from across healthcare.

Data collection is underway for this year’s… Read more »

July 2020

For the fifth consecutive year, CAQH, an industry alliance working to streamline the business of healthcare, has been named one of the “Best Places to Work” by Modern Healthcare.

“As we celebrate the 20th anniversary of CAQH, we know that we would not have been able to achieve as much without a team of innovative, mission-driven professionals dedicated to addressing healthcare’s biggest business challenges,” said Robin Thomashauer, President of CAQH. “While it is an honor to receive this recognition from Modern Healthcare, it is an even greater honor to work every day with such an… Read more »

July 2020

CAQH CORE will be playing an active role in this year’s WEDI Forum, and leading two sessions during the three-day event:

  • Wednesday, August 5th, from 11:30 am - 12:00 pm ET - The CAQH CORE team will be conducting an interactive presentation about the value of earning a CAQH CORE Certification.
  • Thursday, August 6th, from 12:30 - 1:15 pm ET - CAQH CORE Director, Robert Bowman, will give a CAQH CORE update, including recent rule development activities on prior… Read more »
June 2020

SSI Group and Availity, two leading revenue cycle management companies, are the latest organizations to achieve new CAQH CORE Certifications. Both are now CAQH CORE-certified for Prior Authorization & Referrals (infrastructure). Availity also achieved certification for Health Care Claims. Previously, both SSI and Availity were CAQH CORE-certified for Eligibility & Benefits, Claim Status and Payment & Remittance.

CAQH CORE Certification is a voluntary program that recognizes entities that… Read more »

June 2020

Managing coordination of benefits (COB) is challenging for many health plans, but Medicaid plans face among the greatest obstacles. For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly. These plans also have limited resources for identifying third-party liability, although they are required by law to do so.

And now, as team members involved in COB work remotely, these hurdles can become even greater.

In a new white paper, CAQH outlines common pitfalls associated with coordinating benefits… Read more »

June 2020

Now that states have started the process of reopening and our healthcare system is beginning to return to normal operations, this is an ideal time for providers to make sure their professional and practice information in CAQH ProView is up to date.

For providers, the process takes just a few minutes to login to CAQH ProView, update the information and re-attest. This one task ensures every participating plan can access and use the most up-to-date information for claims payment and online directories. Plans should also consider reminding providers whose credentials are about to… Read more »

June 2020

As remote work continues amid the COVID-19 pandemic, CAQH CORE has hosted a series of interactive webinars to bring stakeholders together to discuss some of the industry’s most pressing topics. These virtual sessions have given healthcare leaders a rare opportunity to engage and collaborate during this time of social distancing.  

On June 23rd, CAQH CORE hosted a conversation with CAQH CORE Board members centered around a range of key issues that are shaping the future of the healthcare industry, including value-based payments,… Read more »

May 2020

For years, inaccurate provider directory data has been a concern for the healthcare industry - causing frustration for health plans and providers, and potentially creating barriers to care. As CAQH highlighted in the white paper The Hidden Causes of Inaccurate Provider Directories, one of the causes of directory errors is the administrative burden practices face when responding to a high volume of health plan requests for information and updates.

Read more »
May 2020

Provider data drives the most fundamental processes in the healthcare system. The industry uses provider data to connect patients with healthcare providers, license practitioners, exchange information and pay for services. Though the industry spends more than $2 billion annually to maintain provider data, inaccuracies and inefficiencies persist.

A variety of factors contribute to poor quality provider data, such as the proliferation of proprietary platforms and technologies.

To address this problem, more health plans are seeking to consolidate the management of various… Read more »