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Health plan professionals gather to discuss provider data and other pressing topics 

June 2019

The 2019 CAQH ProView Symposium was held last month in Washington, DC. The event, titled “Achieving Provider Data Excellence,” was attended by representatives from nearly 50 health plans across the nation.

New rules aim to improve prior authorization process

May 2019

Today, 88 percent of prior authorizations are conducted either partially or entirely manually. CAQH CORE has released the Phase V Operating Rules to strengthen the accuracy and trustworthiness of the prior authorization process and move the industry toward full automation.

Be part of the leading industry source for tracking health plan and provider adoption of fully electronic administrative transactions.

May 2019

Recently, the 2018 CAQH Index study revealed that the healthcare industry could save $12.4 billion by transitioning from manual to electronic processes. These critical findings are made possible by voluntary participation from providers and health plans who help to offer a comprehensive view of common business processes across the industry.

CAQH CORE releases new white paper

May 2019

The healthcare industry has made significant progress in adopting electronic transactions for common business practices. However, the lack of a standard for attachments has contributed to cumbersome processes for exchanging patient-specific medical information and supplemental documentation.

Integrated portal creates seamless transition between two CAQH Solutions

May 2019

CAQH continues to make progress in improving provider directory data. Most recently, CAQH launched a new portal that streamlines access to provider directory data by integrating DirectAssure and CAQH ProView.

May 2019

Late last year, CAQH launched CAQH ProView for Groups to simplify the way data is shared between delegated provider groups and health plans. This first-of-its-kind functionality replaces the highly manual processes widely used today with an intuitive, efficient module within CAQH ProView.

March 2019

Artificial Intelligence developed by CAQH is now making it possible to increase the accuracy of healthcare provider directories, without contacting the provider.

March 2019

In a recent milestone for the healthcare system, industry-leading providers, Medicaid programs, health plans, clearinghouses, and product vendors have achieved more than 350 CORE Certifications. Each certification demonstrates a healthcare organization’s commitment to ensuring business transactions flow seamlessly.

Reducing Administrative Costs in Healthcare

March 2019

CAQH recently submitted a letter to the Senate Committee on Health, Education, Labor and Pensions (“HELP Committee”) with recommendations to reduce administrative costs in healthcare. In response to a

March 2019

Of the many business transactions measured in the 2018 CAQH Index, claims status inquiries offer the healthcare system the greatest per-transaction opportunity for cost savings. Despite fewer claim status inquiries occurring overall compared to the prior year, a significant savings opportunity remains because the transaction is highly inefficient when not conducted electronically.

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