November 2016

Enrolling healthcare providers in state-operated Medicaid programs and Managed Care Organizations (MCOs) is a cumbersome and expensive manual process involving long lead times, billing and reimbursement issues, as well as significant data entry.

At a presentation for the Medicaid Enterprise Systems Conference, CAQH Director Ann Brisk discussed trends in Medicaid provider enrollment with Steven A. Smith and Dennis Elliot of TennCare, the Tennessee Medicaid program. Smith and Elliot shared the TennCare story of how they streamlined the enrollment and verification process to improve… Read more »

November 2016

A unified approach to collecting, maintaining and disseminating accurate and timely provider data is critical to improving the quality and cost of healthcare delivery, according to a new CAQH white paper, “Defining the Provider Data Dilemma: Challenges, Opportunities and Call for Industry Collaboration.”

Provider data is used to perform a number of essential functions in the healthcare system, such as referring a patient to a specialist, paying insurance claims, credentialing providers and determining… Read more »

November 2016

More than 100 industry leaders from health plans, healthcare provider organizations, government, consumer groups and others participated in a CAQH-convened Summit on Sept. 29th to develop a path forward for solving healthcare provider data challenges.

The discussion was… Read more »

October 2016

System-wide adoption of electronic funds transfer (EFT) and electronic remittance advice (ERA) has the potential to save the healthcare industry nearly $2.3 billion, according to the CAQH Index. While more than half of these transactions are now conducted electronically, greater adoption would enable health plans and healthcare providers to achieve greater administrative efficiencies and savings.

Under the Affordable Care Act, health plans are required to offer an electronic payment option to healthcare providers. While the move toward… Read more »

October 2016

From greater implementation of the CAQH CORE operating rules to research on the operational needs of the industry to support value-based payments, CAQH CORE continues to identify and implement opportunities that drive the industry toward true interoperability and electronic data exchange. These topics, among others, were highlighted in a recent Town Hall webinar in which CAQH CORE provided progress updates and discussed initiatives underway to enhance the exchange of electronic data in healthcare business transactions.

Gwendolyn Lohse, Deputy Director of CAQH, noted that the CAQH… Read more »

August 2016

Health plan business partners increasingly recognize that, by becoming CORE-certified, they can help their clients meet requirements under the Affordable Care Act (ACA) to conduct secure and efficient administrative data exchange. Business partners may include vendors, clearinghouses, third party administrators (TPAs) and other entities that help health plans and healthcare providers process transactions more efficiently.

CORE Certification is the gold standard for demonstrating that an organization or product operates in agreement with the operating rules and the underlying… Read more »

August 2016

The CAQH Index is now recruiting health and dental plans and healthcare providers (including provider practices, hospitals and health systems) to participate in the 2016 Index.

Broad multi-stakeholder participation in the CAQH Index helps establish valuable industry benchmarks on the adoption and cost savings of automated business transactions. By participating as a data contributor, organizations at every stage of adoption provide valuable information, enabling robust monitoring of… Read more »

May 2016

How does your organization compare to the rest of the healthcare industry in adopting electronic business transactions? The 2015 CAQH Index offers benchmark data, enabling organizations to see where they are excelling and where opportunities for improvement exist.  Specifically, the Index measures adoption rates, cost, and savings associated with the shift from manual to electronic HIPAA transactions between health plans and healthcare providers.

While there have been steady increases in the industry adoption of HIPAA electronic administrative transactions, the recently released… Read more »

May 2016

In a recent letter to the National Committee on Vital and Health Statistics (NCVHS), the multi-stakeholder CAQH CORE Board urged the recommendation of the Phase IV CAQH CORE Operating Rules to the Secretary of the Department of Health and Human Services (HHS). The letter is signed by CAQH CORE Board representatives from CHRISTUS Health, Aetna, Marshfield Clinic Health System, Montefiore, New… Read more »

May 2016

As with other segments of healthcare, dental plans and dentists need to operate more efficiently to succeed amidst rising cost pressures and demand for high quality, affordable care. CAQH initiatives are helping the dental industry address business challenges through collaborative efforts that simplify administrative processes and reduce costs. Dental plans and dentists can participate in several CAQH initiatives to streamline their business processes.

CAQH CORE

Participate with CAQH CORE, an industry-wide collaboration that… Read more »