May 2020

Epic, an industry-leading software provider, has become the newest member of  the CAQH CORE Board. Founded in 1979, Epic now handles medical records for more than 250 million people worldwide through its catalogue of software platforms. Their technology is widely used in hospitals, retail clinics, independent practices and academic medical centers, among other settings.

“As one of the most widely used electronic medical records platforms in the United States, Epic has an invaluable perspective on interoperability, automation and connectivity,” said April Todd. “We are thrilled to… Read more »

May 2020

CAQH employees have come together—virtually—to show their support for healthcare workers on the frontlines of COVID-19. Responding to Children’s National Hospital’s urgent need for iPads compatible with systems in their containment area, treatment rooms and other facilities, team members from across CAQH collected enough funds to donate thirty devices. The iPads have been put to immediate use by emergency department doctors.

CAQH is proud of and inspired by its employees and the generosity they have shown during this difficult time.

April 2020

Our nation’s healthcare system is being tested like never before. In the fight against COVID 19, healthcare workers are putting their lives on the line around the clock. Health plans are doing everything possible to expand access, remove barriers and support those delivering care. 

At CAQH, we want to say thank you to all of those who are working so hard and sacrificing so much. 

We also want them to know that we will continue to deliver the services and solutions that they have come to rely on. Our employees are working virtually—apart, yet in concert—to provide seamless… Read more »

April 2020

At CAQH, we continuously search for new ways to streamline administrative processes for providers, health plans and other participating organizations. To simplify how providers complete their initial profile, the CAQH ProView application will no longer require the Attestation Authorization and Releases (AARs) to be hand signed. Beginning immediately, we will also accept computer-generated signatures.

Please note, this change does not apply in the following thirteen states which continue to require wet signatures: CO, GA, IL, MA, MN, MS, NV, NC, OK, OR, TX, WA and WV

This… Read more »

April 2020

The following CAQH ProView® releases will be effective April 20, 2020:

License Upload Requirements Follow Relaxed FSMB Rules

In response to COVID-19, the Federation of State Medical Boards (FSMB) relaxed rules regarding physician licensure during the State of Emergency, extending physician renewal dates as much as 90 days after the end of the emergency, varying by state.

With this release, providers will no longer be required to upload a license copy to their CAQH profile. This enhancement will benefit providers… Read more »

April 2020

X12 and CAQH CORE will host the Introduction to the 278 Transaction, Standard and Operating Rules webinar on April 30 at 2:00 pm ET. During this session, experts from both organizations will provide insights into how to utilize this transaction to electronically submit prior authorization and referral requests. They will also discuss how CAQH CORE Operating Rules for Prior Authorizations can further standardize components of this process across healthcare.… Read more »

March 2020

Recently, representatives from health plans across the country convened in Washington DC for the third COB Smart Symposium. The event represents a rare opportunity for thought leaders to meet in person to share best practices and collaborate on strategies to improve the coordination of benefits (COB) process.

Traditionally, COB is managed through manual, reactionary processes that often result in unnecessary administrative burdens, and lost revenue. However, plans are increasingly adopting automated processes that allow them to manage payments before a claim is submitted.

Read more »

March 2020

Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies, has joined other national health benefits companies in the effort to improve the accuracy of health care provider directories by participating in CAQH DirectAssure®.

“Our nation’s fragmented approach to maintaining provider directories is undermining the quality of the data and imposing a costly burden on providers,” said CAQH President Robin… Read more »

March 2020

CAQH CORE has voted to set two-day time limits on how quickly health plans must request additional supporting information from providers and make final determinations on prior authorization requests.

“Prior authorizations serve as a check on the safety and appropriateness of medical treatments, but when they take too long, they can delay patient care,” said Dr. Susan Turney, CEO of Marshfield Clinic Health System and CAQH CORE Board Chair. “With today’s announcement, the industry has reached a compromise to ensure they are done… Read more »

January 2020

CAQH has released the seventh annual report measuring the progress made by the healthcare industry in reducing the costs and burden associated with administrative transactions through automation. The 2019 CAQH Index found that, of the $350 billion dollars widely cited as the cost of administrative complexity in the US healthcare system, $40.6 billion is spent on eight administrative transactions. Of that, the industry can save $13.3 billion, or 33 percent of existing annual… Read more »