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
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.
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 Formal Voting Process. This process will require the Rules Work Group, Technical Work Group and Certification & Testing Subgroup to review the draft rules and develop the associated Phase V CORE Certification Test Suite. In an effort to enhance collaboration across the healthcare industry, please consider participating in one or… Read more »
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 »