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 Mexico Cancer Center, Anthem, AultCare, Blue Cross Blue Shield North Carolina, United Health Group, Allscripts, and Athenahealth. As the HHS-designated operating rules authoring entity and per the… Read more »
Responding to consumer concerns about the quality of healthcare provider directories, a number of federal and state directory requirements have recently gone into effect. Health plans must now regularly update and confirm the accuracy of their provider information, or face potential penalties. CAQH is helping health plans address these requirements with the launch of DirectAssure, which works in concert with CAQH ProView to improve provider directory data. This latest CAQH Solution eliminates the need for each health plan to reach out to the individual healthcare providers in their network to… Read more »
Reliable provider data is necessary not only for care delivery, but also for efficient financial processes in healthcare. The need for accurate and timely provider data is continuing to grow. The healthcare industry is discovering new ways to share responsibility for quality provider data as government programs expand, new payment models evolve, cost pressures heighten and demands for transparency increase. Executives Tim Kaja, SVP at UnitedHealth Group and Mariann Yeager, CEO of The Sequoia Project recently participated with CAQH in a panel discussion about provider data at the eHealth… Read more »
CAQH CORE recently announced that it has awarded more than 200 CORE Certifications. Created and maintained with broad multi-stakeholder input, the CORE Certification program works with independent testing entities to evaluate whether organizations applying for certification use information systems that conform to the standards and operating rules. Although CORE Certification is voluntary, health plans and hospital systems across the US are increasingly expecting their business partners to have earned the CORE Certification seal. The CAQH CORE Board Chair, George S. Conklin, CIO and SVP for… Read more »
CAQH recently hosted a webinar with Kaiser Permanente and Blue Cross and Blue Shield of North Carolina (BCBSNC) to discuss how health plans can improve coordination of benefits (COB) through greater industry collaboration. Both health plans implemented a collaborative, secure solution to automate COB. View the On-Demand Webinar or read an Executive Summary of the event to learn more about the challenges being addressed and the results being experienced by both organizations.
“Collaborating to Take Costs Out of the Business of Healthcare”
Collaborative projects are advancing operational efficiencies, improving health plan and provider relations and reducing millions in costs for the healthcare system at large, according to examples recently provided by senior executives from three national health plans at AHIP Institute 2015. The presentation by CAQH explored the advantages of using industry-wide collaboration to improve routine business processes. In the session, titled “Collaborating to Take Costs Out of the Business of Healthcare,” panelists explained how this approach helps ease the burden on individual health plans and… Read more »
At the inaugural hearing of the Affordable Care Act (ACA)-mandated Review Committee in June, CAQH CORE presented compelling testimony that operating rules have resulted in significant contributions to the business needs of the healthcare industry. CAQH CORE also emphasized that many opportunities still exist to use operating rules to achieve interoperable data exchange. The Review Committee was created via the Affordable Care Act to periodically review existing administrative transactions for which standards, code sets, identifiers, or operating rules have already been adopted by mandate and… Read more »