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 »
November 2018
CAQH received a Best Place to Work in Healthcare award from Modern Healthcare 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 to receive this recognition from Modern Healthcare and I am deeply grateful to be working with such a talented,… 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
The ongoing need to reduce administrative expenses in healthcare—while concurrently increasing information accuracy—is at the heart of CAQH activities that benefit the healthcare providers, health plans and agencies that serve Medicaid patients. CAQH CORE® Medicaid agencies and health plans have a significant opportunity to save more than $4.8 billion annually by adopting CAQH CORE Operating Rules for electronic transactions as verified by certification. CAQH CORE has developed and issued four phases of operating rules that support standards, accelerate interoperability and simplify… 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 »
July 2018
CAQH is pleased to announce that our work to simplify the business of healthcare is having an increasing impact. As we hire more staff to meet new demands for our growing portfolio of solutions, we have outgrown our current office space. CAQH is moving its physical address in Washington, DC, in August. CAQH will be relocating to: 2020 K Street, NW Suite 900 Washington, DC 20006 CAQH fax and phone numbers, the CAQH website and email addresses will not change when CAQH moves. CAQH does not anticipate any disruption in service during this change.  
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 »