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December 2017

There is widespread consensus that administrative costs in healthcare are excessive. By some estimates, more than $300 billion each year is spent conducting basic business transactions between healthcare providers and health plans. Much of this expense can be attributed to resource-intensive manual processes, such as phone calls to verify patient coverage or mailing claims and paper checks. 

Each year, CAQH collects data from health plans and providers on the shift from manual to electronic business transactions. The findings are compiled in the CAQH Index, the industry source on trends in adoption rates and cost savings associated with automation.

October 2017

In an effort to reduce administrative burdens for all dentists, the ADA and CAQH have formed a strategic alliance to help streamline the credentialing process for dentists, dental plans and employers. The ADA® credentialing service, powered by CAQH ProView®, enables dentists to enter their professional and practice information one time in an easy-to-use, fast and protected digital platform.

ADA is widely promoting this service to all U.S. practicing dentists, including its membership of 161,000 dentists. The number of dentists participating in CAQH ProView is expected to increase substantially, making it the leading industry source for dentists’ credentialing data.

October 2017

What will it take to achieve consistent, high-quality healthcare provider data for industry stakeholders and patients?

From paying a claim to developing a provider directory, accurate, timely and complete provider data is necessary to conduct business in healthcare. However, efforts to collect provider data are still conducted using a piecemeal approach. Redundant and time-consuming tasks cost the commercial healthcare industry an estimated $2.1 billion annually.

October 2017

The credentialing verification process in healthcare can be inefficient. Health plans often use manual processes to verify provider information, which can lead to errors and incomplete files. Delays in the process also contribute to long lead times before a provider can join a new network.

Opportunities to lower costs and increase file accuracy are a few reasons why health plans are exploring ways to improve their provider credentialing process and reduce administrative burdens.

October 2017

The healthcare economy is going digital. However, a minimum of 1.1 million labor hours of manual administrative work goes into conducting basic transactions each week. For example, up to 40 percent of claim payments and remittance advices, are still done the old-fashioned way—by hand.

The financial services industry offers an interesting comparison. Today, consumers enjoy automated cash withdrawals, global banking and routine streamlined transactions. While healthcare is a more complex industry with many more stakeholders, there are lessons that can be applied from the banking world.

August 2017

There has long been an industry imperative to improve the quality of information in health plan provider directories. Over the last two years, new federal and state regulations have added pressure, requiring strategies that prioritize error removal and strengthen provider engagement.

Federal regulations now require Medicare Advantage, Medicaid and Qualified Health Plans to conduct routine provider outreach or submit more frequent updates that can include monthly reporting. Plans can be subject to financial penalties if found uncompliant.

August 2017

To learn more about how DirectAssure is improving provider directory data, view a recent webinar that includes a case study by UnitedHealthcare, a DirectAssure participating plan, or contact sales@caqh.org.

August 2017

CAQH ProView was launched on a new platform in 2015 to enable greater flexibility and growth for the solution. CAQH has been working since the launch to improve the accuracy of the data within the platform, and expand its use in addressing additional, industry-wide provider data needs.

Ongoing system improvements contribute to a timely and accurate exchange of data between providers and health plans. In most cases, CAQH ProView is requesting new information from providers that health plans previously secured through phone outreach, requiring practices to field calls and deliver responses to multiple plans. In other cases, more precise information addresses patients’ need for improved provider directories.

August 2017

A new article in Group Practice Journal describes how providers can take greater advantage of the progress made by the CAQH CORE Operating Rules and Certification Program. Written by Susan L. Turney, M.D., CEO of Marshfield Clinic Health System and Vice-Chair of the CAQH CORE Board, the article emphasizes the importance of the work by CAQH CORE to streamline electronic business transactions and the need for greater industry participation in the certification program.

Turney describes how most providers should now have all of their payers—both public and private—conducting real-time processing of eligibility and benefits verification and claim status inquiries. Payers should also be offering the option to electronically receive payments, among other efficiencies in common business transactions due to CAQH CORE initiatives.

August 2017

The 2016 CAQH Index findings were displayed during a Technology and Health poster session at the Academy Health Annual Research Meeting in June. The poster session was part of a three-day annual meeting where more than 2,500 attendees gathered to learn about the latest health services research improving health and healthcare around the globe.

The CAQH Index poster highlighted industry efforts to increase automation of routine healthcare administrative transactions. The 2016 report found that there is more than $11 billion in savings available to medical and dental health plans and providers with greater adoption of electronic transactions.

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