November 2019
A recent CAQH survey uncovered the administrative burden on providers associated with maintaining provider directories. The survey of 1,240 physician practices, conducted in September 2019, determined that directory maintenance costs practices nationwide $2.76 billion annually. Updating directory information costs each practice $998.84 on average every month and requires the equivalent of one staff day per week. The burden associated with directory maintenance is due, in part, to the fact that the average physician practice updates information for 20 health plan contracts, according to the… Read more »
November 2019
For the third consecutive year, CAQH has earned certification for information security from the Health Information Trust (HITRUST) Alliance. By earning this status, CAQH has demonstrated that its solutions meet key healthcare regulations and requirements for protecting and securing sensitive private healthcare information. This achievement places CAQH in an elite group of organizations worldwide. The HITRUST CSF includes federal and state regulations, standards and frameworks and incorporates a risk-based approach to help organizations address challenges through a comprehensive and flexible… Read more »
November 2019
In 2018, 57% of Americans received an invoice for services they thought were covered by insurance, also known as a “surprise bill.” Of that group, 20% reported that these charges were the result of visiting a doctor who was not part of their insurance network. To find an in-network practitioner, including office location, hours and contact information, many consumers rely on their health plan’s provider directory. Although much of the information they contain is submitted to the plan by the providers themselves, directories have come under scrutiny from policymakers for high error rates.… Read more »

Educational series aims to close knowledge gap for common healthcare transactions. 

November 2019
As part of their ongoing work to streamline the business of healthcare, CAQH CORE and X12 are collaborating on a new webinar series. These educational sessions aim to close knowledge gaps and support industry professionals navigating standard transactions and how they interact with the CAQH CORE Operating Rules. The first webinar, Introduction to the 835 Transaction, Standard & Operating Rules, was held earlier this month and provided entry-level information surrounding electronic remittance advice transactions. The full recording is now available, and a follow up is planned for next… Read more »

In a recent Medium post, Rachel Goldstein, Senior Manager at CAQH CORE, takes a look at the history of prior authorization and how we can move forward.

October 2019
A standard electronic method for conducting at least a portion of the prior authorization process has been federally mandated since the early 2000s. However, nearly 20 years later, 88 percent of prior authorizations are still conducted either partially or entirely manually, using faxes and phone calls to request and provide clinical information. When managed this way, prior authorizations can take hours, days and even weeks — leaving patients in limbo. For providers, juggling the individual requirements and processes of each health plan is a significant administrative burden. On average,… Read more »

With 13 percent of beneficiaries reporting that they have additional coverage, the coordination of benefits process for Medicaid plans can be complicated and costly.

October 2019
CAQH estimates that administrative inefficiencies associated with coordination of benefits cost the industry $800 million each year. At the Medicaid Health Plans of America (MHPA) Annual Conference, Morgan Tackett, Senior Product Manager of COB Smart, and Laura Carraway, Senior Vice President of Cost Optimization-Program Integrity Coordination of Benefits at Anthem, shared recommendations for how to make this process more efficient and accurate.   The session, “Claims processing and coordination process benefits,” provided an overview of how health plans are currently approaching this… Read more »

A coordinated approach to provider data management fosters data accuracy and adds efficiency to healthcare administration.

October 2019
Members expect their health plan to deliver reliable and accurate provider information so they can find the care they need. Yet maintaining up-to-date, high-quality provider directories is challenging. About half of all provider location listings have at least one inaccuracy, according to the Centers for Medicare and Medicaid Services (CMS). Provider data standardization can help ensure accurate provider information is available to use for connecting patients with providers, provider licensing and paying for services. High-quality provider information also has the downstream benefit of… Read more »

Even as many dentists retire, a greater number of dental providers are continuing to enter the field.

October 2019
Today, more dentists are practicing each year as the U.S. dental industry is growing1. According to the Health Policy Institute (HPI), the number of practicing dentists is expected to increase between 2.6 and 4.5 percent between 2017 and 20372. The increase in dentists is a positive change for consumers, who need a larger dental population to serve what the American Dental Association (ADA) has identified as a steady increase in demand for dental services. However, the rapid growth of this market also means an influx of dental provider data to manage. Maintaining high quality dentist data… Read more »
September 2019
CAQH CORE and Health Level Seven International (HL7) have come together to accelerate automation and improve interoperability between healthcare administrative and clinical systems. Though this is the first time that these organizations have collaborated on solutions specific to technical and administrative burdens, their complementary individual work has helped improve the electronic exchange of data across the healthcare industry. Together, the organizations will address some of the most pressing issues in the industry, starting with: Prior Authorization Exchange of Medical… Read more »
September 2019
In response to a request for information (RFI) from HHS and CMS, CAQH CORE submitted comments on “Reducing Administrative Burden to Put Patients over Paperwork,” an initiative to focus the healthcare delivery system on patient-centered care, innovation and outcomes. In the response, CAQH addressed: Modification or streamlining of reporting requirements, documentation requirements or processes to monitor compliance to CMS rules and regulations. Aligning Medicare, Medicaid and other payer coding, payment and documentation requirements and processes. Enabling operational flexibility,… Read more »