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 »
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 implementing a shared solution to improve provider directories. CAQH recently announced that managed care plans in Tennessee… 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 accuracy and completeness of credentialing information submitted by healthcare providers to… 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 business processes,” said Robin Thomashauer, President of CAQH. “Humana’s engagement will further advance our mission to make information sharing across the industry more accurate and efficient.” Based in Louisville… 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. For years, plans have struggled to collect and maintain the accurate data they need for credentialing and provider directories from delegated groups. This solution simplifies and streamlines the process and can be accessed through a provider data platform that most plans and providers already use. --… 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® -- enabling health plans to improve data quality and increase the speed of the credentialing process. The Suite eliminates redundant steps and continuously alerts plans to infractions and sanctions. Read more about the benefits of adopting the Credentialing Suite here.