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.
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 the COB process is conducted and… Read more »
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 selection for the Excellence in Health IT award,” said Charles W. Stellar, president and CEO of WEDI. “They are a valued and respected organization within… 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 process… 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 when the CMS… Read more »
CAQH Teams with the American Dental Association (ADA) to Simplify Credentialing Process for Dentists
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 expected to increase… 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 challenges with the help of VeriFideTM, a… Read more »
CAQH CORE Issue Brief: Why the Industry Needs to Lead the Way in Streamlining Healthcare Business Transactions
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 world. A… 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 their own… Read more »
To learn more about how DirectAssure is improving provider directory data, view a recent webinar that includes a case study by UnitedHealthcare, a DirectAssure participating plan, or contact email@example.com.