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 change, which… Read more »
April 2020
The following CAQH ProView® releases will be effective April 20, 2020: License Upload Requirements Follow Changes in 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 that might not have new licenses at their next attestation due to the… 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. This is the latest installment in an educational webinar series that the organizations launched in collaboration last year to close the… 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. Sessions from the… 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 Thomashauer. “The best way to overcome this challenge is for the industry to work together. The participation of Humana, one of the nation’s largest and most… 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 efficiently.” With this operating rule, CAQH CORE… 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 spend, by transitioning to fully electronic processes. While the industry has already avoided $102 billion annually by… Read more »
January 2020
Over the years, healthcare industry stakeholders have implemented a multitude of methods connecting applications, systems and networks to exchange administrative and clinical healthcare data. This has resulted in a fragmented ecosystem that is impeding interoperability and administrative simplification. “Connectivity Conundrum: How a Fragmented System is Impeding Interoperability and How Operating Rules Can Improve It,” a recent white paper from CAQH CORE, is an in-depth study of the challenges and opportunities associated with connectivity and includes: A definition of connectivity and its… Read more »
January 2020
Last year, CAQH implemented several enhancements to CAQH ProView, many of which were inspired by feedback we have received by users. Here are a few highlights: The platform now automatically validates important imformation, such as hospital names, SSN and  NPI 1 to improve data accuracy. Providers can update practice locations in fewer steps and with USPS standardization. Contextual in-app technology now autocorrects entries.  Help desk chat support was expanded and a 24/7 virtual assistant was implemented that users rate with 98 percent satisfaction. To build on this progress, CAQH is… Read more »
January 2020
Two of the nation’s largest healthcare organizations have earned Phase III CAQH CORE certification in recognition of their commitment to streamlining the electronic funds transfer (EFT) and electronic remittance advice (ERA) processes. Learn more about CAQH CORE Phase III rules.