November 2016

Industry Collaboration Crucial for Solving Healthcare Provider Data Challenges

November 2016

A unified approach to collecting, maintaining and disseminating accurate and timely provider data is critical to improving the quality and cost of healthcare delivery, according to a new CAQH white paper, “Defining the Provider Data Dilemma: Challenges, Opportunities and Call for Industry Collaboration.”

Provider data is used to perform a number of essential functions in the healthcare system, such as referring a patient to a specialist, paying insurance claims, credentialing providers and determining sanctions. The real-world effect of poor-quality data on consumers and patients has been recently highlighted through increased regulation to address the quality of health plan directories.

CAQH-Convened Summit Tackles Provider Data Problems with Industry Leaders

November 2016

More than 100 industry leaders from health plans, healthcare provider organizations, government, consumer groups and others participated in a CAQH-convened Summit on Sept. 29th to develop a path forward for solving healthcare provider data challenges.

The discussion was informed by the CAQH White Paper describing the current state of provider data accuracy and efforts to maintain reliable, high-quality data.

Keynote speaker Shantanu Agrawal, M.D. (pictured above), deputy administrator and director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services, and panelists throughout the day, highlighted areas of concern and described why there is an imperative to address these challenges now. Common themes included the rising costs of healthcare, an evolving provider landscape, new uses for data—such as testing new payment models—and a growing regulatory environment.

How State Medicaid Programs can Improve the Provider Enrollment Process

November 2016

Enrolling healthcare providers in state-operated Medicaid programs and Managed Care Organizations (MCOs) is a cumbersome and expensive manual process involving long lead times, billing and reimbursement issues, as well as significant data entry.

At a presentation for the Medicaid Enterprise Systems Conference, CAQH Director Ann Brisk discussed trends in Medicaid provider enrollment with Steven A. Smith and Dennis Elliot of TennCare, the Tennessee Medicaid program. Smith and Elliot shared the TennCare story of how they streamlined the enrollment and verification process to improve their bottom line.

Large Regional Health Plan Streamlines EFT/ERA Enrollment

November 2016

System-wide adoption of electronic funds transfer (EFT) and electronic remittance advice (ERA) has the potential to save the healthcare industry nearly $2.3 billion, according to the CAQH Index. While more than half of these transactions are now conducted electronically, greater adoption would enable health plans and healthcare providers to achieve greater administrative efficiencies and savings.

CAQH CORE Town Hall Highlights Progress of Operating Rules and Opportunities Ahead

November 2016

From greater implementation of the CAQH CORE operating rules to research on the operational needs of the industry to support value-based payments, CAQH CORE continues to identify and implement opportunities that drive the industry toward true interoperability and electronic data exchange. These topics, among others, were highlighted in a recent Town Hall webinar in which CAQH CORE provided progress updates and discussed initiatives underway to enhance the exchange of electronic data in healthcare business transactions.



UPCOMING: CAQH CORE Town Hall National Webinar

November 3, 2016, 2:00 PM ET

CAQH CORE Town Hall webinars provide the public with an update on CORE's recent activities related to industry development and/or implementation of healthcare operating rules. Learn about federally mandated and voluntary CAQH CORE Operating Rules, voluntary CORE Certification, and much more. Register.

UPCOMING: Phase IV CAQH CORE Operating Rule Connectivity Implementation Experience with PokitDok and BNETAL

November 10, 2016, 2:00 PM ET

Hear from PokitDok, a provider-facing vendor, who recently implemented the connectivity requirements of the voluntary Phase IV CAQH CORE Operating Rules. Also, get an overview of the Phase IV connectivity requirements from technical experts at BNETAL. Register

UPCOMING: Latest News and Dialogue on the Value of Healthcare e-Payments

November 17, 2016, 2:00 PM ET

Receive updates from CAQH CORE, CAQH, NACHA and WEDI on the value of healthcare e-payments and interconnected payment-remittance transactions (Phase III CAQH CORE Operating Rules). Register.

UPCOMING: Training Session on Annual Industry Opportunity to Make Changes to the CAQH CORE Code Combinations – the 2016 Market-Based Review

December 8, 2016, 2:00 PM ET

Receive updates from CAQH CORE, CAQH, NACHA and WEDI on the value of healthcare e-payments and interconnected payment-remittance transactions (Phase III CAQH CORE Operating Rules). Register.

New CAQH Staff

Abdullah Awaysheh, Data Analyst 

Abdullah is focusing on data quality analytics and reporting for COB Smart. He was previously at Virginia Tech, where he completed his PhD in biomedical and veterinary sciences with a concentration in medical informatics. During his studies at Virginia Tech, he gained expertise in data standardization, data mining and analysis and machine learning.

Joni Hong, Senior Counsel

Joni serves as the central point of contact for all CAQH legal affairs and oversees CAQH contracting requirements. Most recently, Joni served as senior counsel and compliance officer for America’s Health Insurance Plans (AHIP) and previously held several key roles within the AHIP Department of Public Policy and Research.  

Dominique McBride, Data Analyst

Dominique works on a broad range of analysis projects for CAQH solutions, including ProView, DirectAssure and Primary Source Verification. Dominique has nearly 10 years of experience in business analysis and IT consulting in federal agencies, and combines analytical skills with a strong understanding of business and financial processes.

David Patenaude, Senior Security Analyst

David is a member of the Information Security team and responsible for security analysis, tools utilization and security program management. Prior to joining CAQH, David held positions at the National Rural Electric Cooperative Association where he monitored and enhanced security posture for the organization.

CAQH in the News


Healthcare Alliance Urges Framework for Data Quality

Zelis Payments Becomes the First Electronic Reimbursement Solution to Participate in EnrollHub

Standardized Provider Data a Must for Health Data Exchange

CAQH Seeks to Expand Definition of Providers

Morning Consult Chart Review: Defining the Provider Data Dilemma

Simplifying the Way to Billions in Healthcare Savings

Integration Challenges in Healthcare

From Policy to Bottom Line: Improving Revenue Cycle Performance with the ACA’s Administrative Simplification Provisions

Electronic Claim Attachments: Why are Dental Offices Still Lagging Behind?

Credentialing and its Importance in Healthcare Staffing

As Healthcare Digitizes, Medical Referrals Fall Far Behind