February 2019

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.

COB Smart simplifies coordination of benefits so claims can be paid correctly the first time. The unique solution uses a registry of information submitted weekly by participating plans to not only find members with overlapping coverage, but also identify which plan should… Read more »

February 2019

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. And 86 percent indicated that the burden associated with PA in their practice was high or extremely high, requiring an average… Read more »

January 2019

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:

The adoption of electronic… Read more »

January 2019

Accurate provider directory information is an imperative for the U.S healthcare system. It impacts the ability to find a healthcare provider and plays an important role in access to care. Yet, maintaining up-to-date provider directories is too often a burdensome and highly manual process for both health plans and providers.

Nationwide, policymakers and industry stakeholders are diligently working to fix this problem. Some states are taking a proactive approach and… Read more »

January 2019

The credentialing process can be cumbersome for both healthcare providers and health plans. After provider data collection, health plans defer credentialing decisions until they complete primary source verification (PSV). The PSV process is often time-consuming and results in redundant outreach as multiple plans request the same information from a provider.

For health plans looking to reduce the burden of provider data verification, VeriFideTM can help. This automated CAQH Solution authenticates the… Read more »

January 2019

CAQH recently announced that Humana has joined the organization as a member health plan and is now represented on the CAQH board of directors. Humana has participated in CAQH initiatives for many years and is strengthening its commitment to streamline healthcare business processes by becoming a member.

“We are thrilled that Humana will help lead the effort to improve healthcare… Read more »

November 2018

CAQH announced the launch of CAQH ProView for Groups, a solution that is simplifying the way data is shared between delegated provider groups and health plans. It is the first-of-its-kind solution, replacing a highly manual process with an intuitive, efficient module within CAQH ProView.

Read more »

November 2018

In response to the growing need for more streamlined and accurate provider credentialing, CAQH established an end-to-end process that simplifies data collection, primary source verification and sanctions monitoring. The Credentialing Suite includes three prominent CAQH Solutions -- CAQH ProView®, VeriFide™ and SanctionsTrack® --… Read more »

November 2018

CAQH CORE has continued to work and educate industry leaders on the importance of improving the prior authorization process. At the end of September, the Prior Authorization Subgroup completed the development of draft operating rules, which will now go through the… Read more »

November 2018

CAQH received a Best Place to Work in Healthcare award for the third year in a row. For more than a decade, Modern Healthcare has awarded the “Best Places to Work in Healthcare” to outstanding employers that empower and support their staff to make an impact within the healthcare system.

What makes CAQH special is our diverse group of professionals who are passionate about solving important challenges faced by our nation’s healthcare system. It is an honor… Read more »