Dental Industry Finds Value in CAQH Initiatives

May 2016

As with other segments of healthcare, dental plans and dentists need to operate more efficiently to succeed amidst rising cost pressures and demand for high quality, affordable care. CAQH initiatives are helping the dental industry address business challenges through collaborative efforts that simplify administrative processes and reduce costs. Dental plans and dentists can participate in several CAQH initiatives to streamline their business processes.


Participate with CAQH CORE, an industry-wide collaboration that drives the creation and adoption of healthcare operating rules. The rules support standards to accelerate interoperability and align administrative and clinical activities among providers, health plans and consumers. CAQH CORE gives participating dental plans a direct voice in the development and maintenance of operating rules.

Achieve voluntary CORE Certification. Dental plans operating in conformance with the CAQH CORE Operating Rules and their underlying standards can demonstrate this achievement to their trading partners and the industry by becoming CORE-certified. HIPAA-covered dental plans are required to be compliant with federally mandated operating rules. The first set of dental-specific plans have recently achieved CORE Certification, including Delta Dental of California and Dentegra, and others are pledged. Additionally, general medical healthcare plans that offer dental coverage, such as Humana, Cigna, and Aetna are also CORE-certified, including their dental business.  

Contact CAQH CORE for more information.

CAQH Index: Now includes Dental

Contribute data to the CAQH Index, the industry source for tracking adoption of HIPAA-mandated electronic administrative transactions and the associated cost savings. A voluntary national initiative, the Index collects and analyzes claims-related transaction data from commercial medical and dental health plans and healthcare providers. The 2015 Index includes a first-ever, separate report of adoption for the dental industry. It includes metrics based on submissions from dental plans representing more than 92 million covered lives and nearly 440 million administrative transactions.

Benchmark progress. Adoption of fully electronic transactions was significantly lower for the dental health industry compared to medical, ranging from nearly 17 percentage points lower for eligibility and benefit verifications to 55 percentage points lower for claim payment, according to the 2015 report. Another key finding from the report was a notably larger share of claim status inquiries were conducted using web portals and interactive voice response (IVR) systems, compared to medical (46.3% vs. 34.2%).   The dental industry can compare their own individual organization or dental plan progress with this data to determine opportunities for greater efficiency.

Contact CAQH Explorations for more information.

CAQH Solutions

Aligned with its mission to accelerate the transformation of business processes in healthcare, CAQH collaborates with key stakeholders to develop industry utilities (CAQH Solutions) aimed at streamlining key administrative processes. CAQH Solutions help reduce administrative costs and increase automation for the dental industry.


Dental plans can participate with EnrollHub to increase efficiencies and reduce costs by moving redundant electronic funds transfer (EFT) and electronic remittance advice (ERA) functions, such as enrollment validation, into a shared industry-wide service. Three of the top five national dental plans, representing more than 30% of the dental insurance marketplace, are using EnrollHub to enroll dental providers in EFT and ERA.

Dentists can use EnrollHub to get started with electronic payments and remittance. Dentists access a single, easy-to-use point of entry to enroll in and manage EFT and ERA information with multiple payers. The solution eliminates the need for dentists to complete and submit the exact same data elements to each plan through their individual enrollment processes. To encourage rapid and widespread enrollment, CAQH offers EnrollHub at no charge to all healthcare providers, including dentists.

CAQH ProView

Dental plans can join over 800 participating organizations that rely on CAQH ProView as a trusted, proven industry solution for provider data collection, maintenance and distribution. No other resource in the industry includes this depth and breadth of provider data.  More than 1.3 million providers of all types use CAQH ProView to manage their provider profile.

Dentists can manage their professional and practice information through a single online profile. CAQH ProView eases the burden of provider data for a variety of dental plan needs including credentialing, provider directories, claims adjudication and more. Offered to dentists at no charge, it enables a single process for them to report professional and practice information one time and then easily share it with the dental plans they authorize to receive it – saving time and reducing paperwork.


Dental plans can participate with DirectAssure to ease the administrative burden associated with maintaining dental plan provider directories, while helping improve the quality of this information. The solution enables dentists to review, update and confirm their data using CAQH ProView, eliminating the need for each dental plan to frequently contact every dentist in their network to obtain timely, correct information. DirectAssure, an add-on solution used with CAQH ProView, helps plans meet federal and state provider directory requirements.

Contact CAQH Solutions for more information.

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