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 well as basic and on-demand reporting. This year, CAQH plans to add additional enhancements to the new DirectAssure portal… 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 errors. Participating plans then receive higher quality provider data that can be… 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 This new technology is helping plans overcome a longstanding challenge -- Incomplete, inaccurate and outdated provider data has been a pervasive problem for the healthcare system for years.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 (CMS) began conducting annual reviews of Medicare Advantage online provider directories in 2016. Since then, failure to maintain accurate provider directory… 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 Medicaid lives in the United States. CORE Certification is available for four phases of operating rules that encompass… 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 health care system; (ii) rationalize state and federal regulatory requirements regarding provider data; (iii) accelerate adoption of administrative standards and operating rules; and (iv) urge HHS to immediately… 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 inquiries. For claim status inquiries, the Index… 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 rosters that… Read more »
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 pay first. Health plans that have measured… 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 of nearly two business days per week. According to the latest CAQH Index, little… 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 transactions improved for most… Read more »