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Integrated portal creates seamless transition between two CAQH Solutions
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.
Artificial Intelligence developed by CAQH is now making it possible to increase the accuracy of healthcare provider directories, without contacting the provider.
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
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
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.
MD-Staff Generating CAQH ProView for Groups-compatible Rosters
The traditional model of sharing data between delegated healthcare provider groups and health plans is complex for all parties. Plans frequently receive delegated group information in varying formats and at different times. Delegated groups must maintain unique rosters and change reports for each plan, and typically do not know when plans process their data.
Challenges related to coordination of benefits (COB) are a financial drain for health plans and a headache for providers. Claim payments are often made in error or delayed due to complicated manual processes, as well as a lack of clarity on which plan should be the primary payer.
Prior authorization (PA) is a common source of frustration in healthcare. According to a recent survey from the American Medical Association, 28 percent of providers reported that the PA process has affected care delivery and led to a serious adverse event. Notably, 88 percent said the burden associated with prior authorization has increased over the last five years for their practice.
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:
Recent Catalyst Articles
- Deadline Extended: Exchanging Medical Documentation Survey
- Industry Progress on Improving Prior Authorizations
- Presentation Showcases How Medicaid Plans Can Improve Coordination of Benefits
- Industry Collaboration Improves Provider Directories
- Dental Market Expansion
- CAQH CORE and HL7 Announce Collaboration
- CAQH CORE Comments on Administrative Burdens to HHS and CMS
- Moving Medicaid Plans Beyond Pay and Chase
- CAQH Presents to National Conference of State Legislators
- CAQH ProView for Groups is Improving Delegated Roster Processes