October 2020
WEDI has announced that CAQH and CAQH CORE will be leading two sessions at the organization’s upcoming National Conference: The CAQH CORE Attachments Update (10/16 from 12:45-1:30 ET). During this interactive session, Robert Bowman, Director, CORE, will provide an update on CAQH CORE operating rule development related to attachments and the electronic exchange of additional medical documentation to support prior authorization and claims. To learn more about CAQH CORE Attachment Initiatives, click here. CAQH Endpoint Directory Overview & Demo (10/21 from 3:00-3:45 ET). CAQH will provide… Read more »
October 2020
In August, CAQH CORE hosted a webinar to share initial findings of the Prior Authorization Pilot & Measurement Initiative, which works with industry organizations to measure the impact of standards and operating rules on efficiency metrics and staff experience. The case study webinar with Cleveland Clinic and PriorAuthNow, the first in a series, highlighted the impact that prior authorization (PA) automation and workflow integration may have on the health system. Attendees learned how the implementation of a PA solution leveraging the standard transaction and CAQH CORE PA operating… Read more »
October 2020
To mark the 20th anniversary of CAQH, this year’s annual report tells the story of the organization’s founding, provides highlights from initiatives over the years, and outlines its vision to transform the business of healthcare in the future. Click here to read the 2019 CAQH annual report.
August 2020
Health insurers use prior authorization as a check on the safety, quality, necessity and cost of medical services. When done manually, this process can be confusing, labor-intensive and expensive for the provider and payer teams that manage it. This can create delays to patient care, and frustrations across the industry. This month, CAQH CORE proposed three Prior Authorization & Connectivity Operating Rules to accelerate automation of the prior authorization process at a hearing with the National Committee on Vital and Health Statistics (NCVHS), an advisory committee to the Secretary of… Read more »
August 2020
CAQH has earned certifications for information security by the Health Information Trust (HITRUST) Alliance for CAQH ProView®, COB Smart®, EnrollHub®, DirectAssure®, VeriFide™ and SanctionsTrack®. With the HITRUST CSF Certified Status, these products have been proven to meet important regulations and requirements for protecting and securing sensitive private healthcare information. This achievement places CAQH in an elite group of organizations worldwide that have earned this certification. The HITRUST CSF is a thorough evaluation that includes federal and state regulations, standards and… Read more »
August 2020
CAQH has announced its support for a resolution passed by the National Lieutenant Governor’s Association (NLGA) recognizing the need for administrative simplification in our nation’s healthcare system. The resolution highlights that “spending on healthcare administration costs an estimated $350 billion annually in the United States due to inefficiency and complexity, and despite healthcare industry progress to automate and reduce costs associated with administrative functions, the United States still spends more on healthcare and administrative services than any other developed nation.” It… Read more »
August 2020
As national unemployment rates climb to historic levels, states and payers are experiencing weekly enrollment shifts in Medicaid, ACA marketplaces and employer sponsored insurance. To identify beneficiaries with overlapping health coverage, Medicaid programs need to establish coordination of benefit (COB) strategies that are scalable, accurate and cost effective. On September 24th, CAQH and the Florida Association of Health Plans will be hosting the Keys to Managing COB in a Crisis, an interactive webinar that will teach attendees best practices for boosting cost avoidance, reducing… Read more »
July 2020
Beginning in July 2000, the founding CAQH members launched a series of initiatives to improve the quality of healthcare and reduce administrative burdens for physicians, patients and payers. These first programs were designed by work groups of health plan and CAQH staff, developing tools and technologies to support physicians and educate patients about vital health issues and insurance benefits. While today CAQH is focused on streamlining business challenges, some of the early initiatives addressed clinical issues. Here are a few examples: Health Outcomes. CAQH members leveraged their… Read more »
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, Len Schaeffer from then… 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 inspiring… Read more »