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… Read more »

December 2017

CAQH, a nonprofit alliance of health plans and related associations, recently received the “Excellence in Health IT Award” from the Workgroup for Electronic Data Interchange (WEDI). Presented during the WEDI annual meeting on December 6, the award recognizes organizations and individuals that have made outstanding contributions to the advancement of information technology (HIT) and eCommerce technology in healthcare.

“CAQH was a natural… Read more »

December 2017

Organizations can now become CORE-certified in the Phase IV operating rules for exchanging administrative data electronically. The rules help streamline prior authorization, healthcare claims, employee premium payments, health plan enrollment and disenrollment, and other transactions.

The Phase IV CAQH CORE Operating Rules address key infrastructure challenges related to the transactions, such as connectivity, processing times and system availability. The operating rules are also a critical step in reducing the time-consuming phone and fax communication in the prior authorization… Read more »

December 2017

CAQH has reduced the number of steps it takes for healthcare providers to enroll in electronic funds transfer (EFT) with payers. Now, in just two clicks—in less than one minute—providers already registered with EnrollHub can sign up to receive electronic payments with additional payers. Previously, providers were required to log into the system, access their account and request enrollment with those payers.

EnrollHub is an on-line, electronic solution that enables providers to enroll in EFT and Electronic Remittance Advice (ERA) through a single, secure application, then share it… Read more »

December 2017

Improving provider directory accuracy continues to be an industry-wide challenge. Periodic reviews from the Centers for Medicare and Medicaid Services (CMS) have intensified pressure on health plans to improve the quality of directories. Plans allocate significant resources to these efforts, which are a portion of the $2 billion spent annually by the commercial healthcare industry to maintain provider data.

CAQH recently surveyed health plans to learn more about their strategies for improving the quality of directory data. At least half reported being audited since January 2016… Read more »

December 2017

There is widespread consensus that administrative costs in healthcare are excessive. By some estimates, more than $300 billion each year is spent conducting basic business transactions between healthcare providers and health plans. Much of this expense can be attributed to resource-intensive manual processes, such as phone calls to verify patient coverage or mailing claims and paper checks. 

Each year, CAQH collects data from health plans and providers on the shift from manual to electronic business transaction. The findings are compiled in the CAQH Index, the industry source on… Read more »

October 2017

In an effort to reduce administrative burdens for all dentists, the ADA and CAQH have formed a strategic alliance to help streamline the credentialing process for dentists, dental plans and employers. The ADA® credentialing service, powered by CAQH ProView®, enables dentists to enter their professional and practice information one time in an easy-to-use, fast and protected digital platform.

ADA is widely promoting this service to all U.S. practicing dentists, including its membership of 161,000 dentists. The number of dentists participating in CAQH ProView is… Read more »

October 2017

What will it take to achieve consistent, high-quality healthcare provider data for industry stakeholders and patients?

From paying a claim to developing a provider directory, accurate, timely and complete provider data is necessary to conduct business in healthcare. However, efforts to collect provider data are still conducted using a piecemeal approach. Redundant and time-consuming tasks cost the commercial healthcare industry an estimated $2.1 billion annually.

The Provider Data… Read more »

October 2017

The credentialing verification process in healthcare can be inefficient. Health plans often use manual processes to verify provider information, which can lead to errors and incomplete files. Delays in the process also contribute to long lead times before a provider can join a new network.

Opportunities to lower costs and increase file accuracy are a few reasons why health plans are exploring ways to improve their provider credentialing process and reduce administrative burdens.

In an on-demand webinar, Aetna discusses how they are tackling these… Read more »