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 towards full automation.

These new rules build upon the Phase IV Rules and enhance and standardize the data shared… Read more »

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 provide a comprehensive view of common business processes across the industry.

Data collection is now underway for the… Read more »

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.

A new CAQH CORE white paper, which summarizes insights from more than 250 healthcare organizations, identifies five opportunity areas to move the industry… Read more »

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.

Touching more than 1.5 million health plan-provider relationships, DirectAssure is supporting directory accuracy for a large portion of Americans. Participating organizations will now have enhanced capabilities to simplify provider look-up, roster management, as… Read more »

Integrated portal creates seamless transition between two CAQH Solutions

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.

With CAQH ProView for Groups, delegated groups no longer need to maintain a separate file for each contracted plan. Instead, they can submit one standardized file through a centralized portal, which automatically checks for… Read more »

March 2019

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

This new technology is helping plans overcome a longstanding challenge -- Incomplete, inaccurate and outdated provider data has been a pervasive problem for the healthcare system for years. However, the stakes increased when the Centers for Medicare and Medicaid Services… Read more »

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. To date, CORE-certified organizations include health plans that cover 78 percent of commercial lives, 75 percent of Medicare Advantage lives and 44 percent of… Read more »

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 request to stakeholders from HELP Committee Chair Lamar Alexander, CAQH recommended that Congress: (i) establish a goal to reduce unnecessary costs and administrative burdens across the… Read more »

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. According to the most recent Index, the medical industry could still save an estimated $2.6 billion annually by completing the transition to electronic claim status… Read more »

MD-Staff Generating CAQH ProView for Groups-compatible Rosters

February 2019

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.

Applied Statistics & Management Inc. (ASM), through its credentialing system MD-Staff, is working with CAQH to simplify the way groups share provider information with health plans. MD-Staff now automatically generates… Read more »