Newsletter Home Listing

January 2019

The latest CAQH Index report shows that the healthcare industry continues to make progress toward automating business processes as the number of transactions increases. The sixth annual CAQH Index, released earlier this month, is the industry standard for tracking health plan and provider adoption of fully electronic administrative transactions. The report provides insights into how the business of healthcare is changing, calls for greater industry collaboration and identifies opportunities for cost savings. Major takeaways include:

January 2019

Accurate provider directory information is an imperative for the U.S healthcare system. It impacts the ability to find a healthcare provider and plays an important role in access to care. Yet, maintaining up-to-date provider directories is too often a burdensome and highly manual process for both health plans and providers.

January 2019

The credentialing process can be cumbersome for both healthcare providers and health plans. After provider data collection, health plans defer credentialing decisions until they complete primary source verification (PSV). The PSV process is often time-consuming and results in redundant outreach as multiple plans request the same information from a provider.

January 2019

CAQH recently announced that Humana has joined the organization as a member health plan and is now represented on the CAQH board of directors. Humana has participated in CAQH initiatives for many years and is strengthening its commitment to streamline healthcare business processes by becoming a member.

November 2018

CAQH announced the launch of CAQH ProView for Groups, a solution that is simplifying the way data is shared between delegated provider groups and health plans. It is the first-of-its-kind solution, replacing a highly manual process with an intuitive, efficient module within CAQH ProView.

November 2018

In response to the growing need for more streamlined and accurate provider credentialing, CAQH established an end-to-end process that simplifies data collection, primary source verification and sanctions monitoring.

November 2018

CAQH CORE has continued to work and educate industry leaders on the importance of improving the prior authorization process. At the end of September, the Prior Authorization Subgroup completed the development of draft operating rules, which will now go through the Formal Voting Process.

November 2018

CAQH received a Best Place to Work in Healthcare award from Modern Healthcare for the third year in a row. For more than a decade, Modern Healthcare has awarded the “Best Places to Work in Healthcare” to outstanding employers that empower and support their staff to make an impact within the healthcare system.

September 2018

Last month, the CAQH CORE Board submitted an open letter in support of the Consensus Statement on Improving the Prior Authorization Process, which shares many CAQH CORE goals, such as improved transparency and communications, continuity of patient care and automation and efficiency.

Committed to collaborating with industry stakeholders, CAQH CORE is eager to work with the statement’s authoring organizations, which include the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA).

The 2017 CAQH Index found that healthcare provider and health plan adoption of standard prior authorization transactions was only eight percent--one of the lowest adoption rates of all transactions measured in the report. The proportion of prior authorization transactions conducted using that standard actually declined by more than 10 percentage points in comparison to the 2016 CAQH Index. However, automating prior authorization could result in savings of $6.84 per transaction.

September 2018

The ongoing need to reduce administrative expenses in healthcare—while concurrently increasing information accuracy—is at the heart of CAQH activities that benefit the healthcare providers, health plans and agencies that serve Medicaid patients.

Pages