About
CORE
Solutions
ExplorationsIn a recent letter to the National Committee on Vital and Health Statistics (NCVHS), the multi-stakeholder CAQH CORE Board urged the recommendation of the Phase IV CAQH CORE Operating Rules to the Secretary of the Department of Health and Human Services (HHS).
Responding to consumer concerns about the quality of healthcare provider directories, a number of federal and state directory requirements have recently gone into effect. Health plans must now regularly update and confirm the accuracy of their provider information, or face potential penalties. CAQH is helping health plans address these requirements with the launch of DirectAssure, which works in concert with CAQH ProView to improve provider directory data.
Reliable provider data is necessary not only for care delivery, but also for efficient financial processes in healthcare. The need for accurate and timely provider data is continuing to grow. The healthcare industry is discovering new ways to share responsibility for quality provider data as government programs expand, new payment models evolve, cost pressures heighten and demands for transparency increase.
CAQH CORE recently announced that it has awarded more than 200 CORE Certifications. Created and maintained with broad multi-stakeholder input, the CORE Certification program works with independent testing entities to evaluate whether organizations applying for certification use information systems that conform to the standards and operating rules.
Several of the nation’s leading dental plans are enabling dentists to sign up for electronic payments with multiple payers at one time. The plans are participating in EnrollHub® to simplify the process for electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollment, removing a longstanding barrier to broad use of electronic payments among dentists and other healthcare providers.
On-Demand Webinar
CAQH recently hosted a webinar with Kaiser Permanente and Blue Cross and Blue Shield of North Carolina (BCBSNC) to discuss how health plans can improve coordination of benefits (COB) through greater industry collaboration. Both health plans implemented a collaborative, secure solution to automate COB.
Health plans, healthcare providers, and the clearinghouses and vendors that support them, now have national operating rules to improve how they can work together as trading partners. The voluntary operating rules will help streamline the electronic data exchange of four more healthcare business transactions: healthcare claims; prior authorization; employee premium payment; and enrollment and disenrollment in a health plan.
CAQH has launched a redesigned website developed to communicate more effectively and improve the visitor experience. In addition to featuring refreshed branding that represents the mission and vision of the organization, www.CAQH.org now has a new structure that makes information easier to find.
As the scope of CAQH activities expands beyond simplifying administrative processes to focus more broadly on “streamlining the business of healthcare”, the redesigned website more comprehensively profiles the work of the organization.
“Collaborating to Take Costs Out of the Business of Healthcare”
Collaborative projects are advancing operational efficiencies, improving health plan and provider relations and reducing millions in costs for the healthcare system at large, according to examples recently provided by senior executives from three national health plans at AHIP Institute 2015.
At the inaugural hearing of the Affordable Care Act (ACA)-mandated Review Committee in June, CAQH CORE presented compelling testimony that operating rules have resulted in significant contributions to the business needs of the healthcare industry. CAQH CORE also emphasized that many opportunities still exist to use operating rules to achieve interoperable data exchange.
2020 K Street, NW
Suite 900
Washington, DC 20006
