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 »
July 2020
CAQH CORE will be playing an active role in this year’s WEDI Forum, and leading two sessions during the three-day event: Wednesday, August 5th, from 11:30 am - 12:00 pm ET - The CAQH CORE team will be conducting an interactive presentation about the value of earning a CAQH CORE Certification. Thursday, August 6th, from 12:30 - 1:15 pm ET - CAQH CORE Director, Robert Bowman, will give a CAQH CORE update, including recent rule development activities on prior authorization, connectivity, value-based payments and attachments to support standardization in the exchange of administrative and… Read more »
June 2020
SSI Group and Availity, two leading revenue cycle management companies, are the latest organizations to achieve new CAQH CORE Certifications. Both are now CAQH CORE-certified for Prior Authorization & Referrals (infrastructure). Availity also achieved certification for Health Care Claims. Previously, both SSI and Availity were CAQH CORE-certified for Eligibility & Benefits, Claim Status and Payment & Remittance. CAQH CORE Certification is a voluntary program that recognizes entities that create, transmit or use the healthcare administrative and financial transactions following… Read more »
June 2020
Managing coordination of benefits (COB) is challenging for many health plans, but Medicaid plans face among the greatest obstacles. For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly. These plans also have limited resources for identifying third-party liability, although they are required by law to do so. And now, as team members involved in COB work remotely, these hurdles can become even greater. In a new white paper, CAQH outlines common pitfalls associated with coordinating benefits and identifying… Read more »
June 2020
Now that states have started the process of reopening and our healthcare system is beginning to return to normal operations, this is an ideal time for providers to make sure their professional and practice information in CAQH ProView is up to date. For providers, the process takes just a few minutes to log in to CAQH ProView, update the information and re-attest. This one task ensures every participating plan can access and use the most up-to-date information for claims payment and online directories. Plans should also consider reminding providers whose credentials are about to expire—or… Read more »
June 2020
CAQH CORE is hosting a series of interactive webinars to give healthcare leaders an opportunity to engage and collaborate during this time of social distancing.   A June 23rd webinar featured CAQH CORE Board members addressing a range of issues, including value-based payments, interopability and COVID-19. The event was led by Dr. Sue Turney, President and CEO, Marshfield Clinic Health System, Tim Kaja, Chief Operating Officer of UnitedHealth Networks, UnitedHealthcare and Dr. Marilyn Heine (AMA), Clinical Assistant Professor of Medicine, Drexel University College of Medicine. Click here to… Read more »