January 2017
CAQH partnered with dental plan MetLife to host a webinar on their success in increasing provider enrollment in Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) through EnrollHub®. This industry-wide CAQH solution makes it easier for providers to receive claim payment and remittance advice electronically from multiple health and dental plans.  Dental providers previously enrolled in EFT/ERA with MetLife through the company website portal or via fax; both options required manual data entry of the provider information by the plan. With a goal of streamlining the payment… Read more »
January 2017
A new two-minute video by CAQH Commitee on Operating Rules for Information Exchange (CORE®) provides an overview of CORE Certification. This e-program enables entities to demonstrate that they are adhering to the CAQH CORE Operating Rules and underlying standards for administrative data sharing across the healthcare system. Developed by industry for industry, the CORE Certification program is widely recognized as the industry gold standard for testing conformance to the operating rules.   CAQH CORE is the U.S. Department of Health and Human Services designated author of the operating rules… Read more »
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 their… 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 sanctions. The real-world effect of poor-quality data on consumers and patients has been… 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 informed by the CAQH White Paper describing the current state of provider data accuracy and efforts to maintain reliable, high-quality data. Keynote speaker Shantanu Agrawal, M.D. (pictured above), deputy administrator and director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services, and… 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 electronic payments has been steady, it has not gained… 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 CORE… 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 standards… 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 industry progress and potential cost savings. This annual reporting is reliable, useful, and actionable for… 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 2015 CAQH… Read more »