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 »

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 »

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 »

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 »

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 »

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 »

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 »

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 »

The healthcare economy is going digital. However, a minimum of 1.1 million labor hours of manual administrative work goes into conducting basic transactions each week. For example, up to 40 percent of claim payments and remittance advices, are still done the old-fashioned way—by hand.

The financial services industry offers an interesting comparison. Today, consumers enjoy automated cash withdrawals, global banking and routine streamlined transactions. While healthcare is a more complex industry with many more stakeholders, there are lessons that can be applied from the banking… Read more »

There has long been an industry imperative to improve the quality of information in health plan provider directories. Over the last two years, new federal and state regulations have added pressure, requiring strategies that prioritize error removal and strengthen provider engagement.

Federal regulations now require Medicare Advantage, Medicaid and Qualified Health Plans to conduct routine provider outreach or submit more frequent updates that can include monthly reporting. Plans can be subject to financial penalties if found uncompliant.

Many states have also begun creating… Read more »