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For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly.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 »
May 2020
For years, inaccurate provider directory data has been a concern for the healthcare industry - causing frustration for health plans and providers, and potentially creating barriers to care. As CAQH highlighted in the white paper The Hidden Causes of Inaccurate Provider Directories, one of the causes of directory errors is the administrative burden practices face when responding to a high volume of health plan requests for information and updates. Now more than ever, providers and practices need to dedicate all available resources to patient care rather than administrative processes.… Read more »
May 2020
Provider data drives the most fundamental processes in the healthcare system. The industry uses provider data to connect patients with healthcare providers, license practitioners, exchange information and pay for services. Though the industry spends more than $2 billion annually to maintain provider data, inaccuracies and inefficiencies persist. A variety of factors contribute to poor quality provider data, such as the proliferation of proprietary platforms and technologies. To address this problem, more health plans are seeking to consolidate the management of various related functions in… Read more »
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 have their… 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 support to… Read more »