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
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 »
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 »
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 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 »
March 2016
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 »
November 2015
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 »
August 2015
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 »