September 2018
Last month, the CAQH CORE Board submitted an open letter in support of the Consensus Statement on Improving the Prior Authorization Process, which shares many CAQH CORE goals, such as improved transparency and communications, continuity of patient care and automation and efficiency. Committed to collaborating with industry stakeholders, CAQH CORE is eager to work with the statement’s authoring organizations, which include the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross… Read more »
September 2018
HealthCare Administrative Solutions (HCAS), a non-profit organization of Massachusetts-based health plans, has chosen DirectAssure® after an extensive search for a solution to improve healthcare provider directories in the state. With DirectAssure, providers enter their directory information changes once and share them with multiple plans. The solution works in concert with CAQH ProView®, an online database used by more than 1.4 million providers nationwide to maintain their professional and practice information. DirectAssure asks providers to compare and verify practice location information… Read more »
July 2018
CAQH has achieved Certified status for information security by the Health Information Trust (HITRUST) Alliance. The HITRUST certification validates that CAQH meets key healthcare regulations and requirements for protecting and securing sensitive private healthcare information. The certification applies to CAQH infrastructure, security and privacy programs and the entire portfolio of CAQH Solutions (CAQH ProView, DirectAssure, VeriFide, EnrollHub, SanctionsTrack and COB Smart). HITRUST CSF (common security framework) has become the most widely adopted security framework in the U.S. healthcare… Read more »
July 2018
The healthcare industry has made moderate progress in the adoption of electronic business transactions, but significant savings potential remains for healthcare providers and health plans, according to the 2017 CAQH Index released on June 14th. The fifth annual CAQH Index measures adoption, costs and provider labor time associated with the most common administrative transactions conducted between health plans and providers. These include verifying a patient’s insurance coverage, sending and receiving payment, inquiring about the status of a claim and obtaining prior authorization for care. … Read more »
May 2018
The Provider Data Action Alliance (PDAA), a diverse group of 20 healthcare leaders convened by CAQH, has released a roadmap outlining recommendations to address provider data issues impacting healthcare providers, patients and health plans. The industry spends $2 billion annually to maintain provider data, yet errors and inefficiencies remain, disrupting many crucial processes in the healthcare system. “An Industry Roadmap for Provider Data” outlines a core set of principles that can guide the development of an industry solution, a model for what the provider data system should look like and… Read more »
May 2018
Modern Healthcare recognized CAQH on its list of the Best Places to Work in Healthcare for 2018. This is the third year in a row that CAQH has been included on the list of 150 organizations and companies across the U.S. that “stand out in their efforts to create an empowered and satisfied workforce.” Modern Healthcare selects the organizations based on employee feedback through an engagement and satisfaction survey, as well as a review of company policies, practices and demographics. More information about the recognition will be available in September when Modern Healthcare announces… Read more »
March 2018
The U.S. healthcare economy is undergoing a transformation in how care is measured, billed and paid. Organizations around the country are shifting away from fee-for-service models that reimburse providers for the volume of care, and experimenting with value-based payment models, which align quality of care and cost controls with provider compensation. As value-based payment innovation continues, there are many threats to its progress, such as operational challenges. Yesterday, CAQH CORE® released a report highlighting five industry opportunities to streamline value-based payment operations:… Read more »
March 2018
In its second year of adoption, DirectAssure has established itself as a leading solution for health plans to address the ongoing challenge of maintaining accurate provider directories. Making changes to directory information is seamless for healthcare providers, who use CAQH ProView to easily review and update their professional information. DirectAssure participating organizations, including most national plans, are already using the solution to manage directory data for more than 800,000 providers. On average, about 600,000 of those providers review and confirm their information every four… Read more »
March 2018
This May, CAQH is hosting a conference in Washington, DC for health and dental plan managers responsible for provider data, including CAQH ProView administrators. The conference will offer helpful insights for improving provider credentialing, directories and data quality. Attendees will discover how to leverage CAQH Solutions across departments, talk to “power users” about overcoming provider data challenges, preview upcoming enhancements, meet the CAQH Product team, network with peers and more. Contact your CAQH ProView account manager to learn more about this event.
March 2018
In late February, CAQH hosted COB Smart Connection: A Forum for Participating Organizations. The keynote speaker was Jolie H. Matthews, Senior Health and Life Policy Counsel at the National Association of Insurance Commissioners (NAIC). Created in 1871, the NAIC is a nationwide organization that establishes standards to improve the state regulation of insurance, including health and dental. In her keynote speech, Matthews discussed the NAIC adoption of the Coordination of Benefits (COB) Model Regulation in 1971. The model implements guidelines for how the COB process is conducted and… Read more »