April 2017

CAQH Launches New Solution to Improve the Provider Credentialing Process

April 2017

CAQH has developed a groundbreaking solution that reduces the burden – for both health plans and providers – of authenticating the accuracy and completeness of provider information to support credentialing decisions. 

VeriFide™, the provider credential verification solution from CAQH, delivers rapid, high quality data to plans through advanced technologies, economies of scale and – over the next few years – industry-wide alignment of provider credentialing dates. The organization’s goal is to reducing the overlapping, non-differentiating business processes associated with credentialing.

CAQH Provider Directory Solution Demonstrates High Provider Engagement

April 2017

One year after its launch, DirectAssure has become an important resource to help health and dental plans improve the quality of their provider directories. More than 500,000 healthcare providers have reviewed, updated and confirmed their professional information for use in directories, and more than 30 health and dental plans are already participating in this industry-wide solution.

CORE Exceeds 300 Certifications Milestone

April 2017

CAQH CORE announced that it has awarded more than 300 CORE Certifications to health plans, hospitals and health systems, clearinghouses and vendors with recent Aetna and Cigna awards. The continued increase in the number of organizations seeking and receiving certification underscores the value they place on demonstrating that they meet – and exceed – the CORE operating rules and underlying standards for electronic business transactions.  

AIS Health Plan Week Highlights CAQH Work on Provider Data

April 2017

CAQH efforts to convene the industry to solve provider data challenges were discussed in a recent article in AIS Health Plan Week. The article explored the problem from different stakeholder perspectives amid a changing healthcare environment and increased regulations for directory maintenance.

The healthcare industry spends a collective $2.1 billion on inefficient processes maintaining provider data, two-thirds of which are health plan expenses. The lack of trusted sources of information have led to the proliferation of highly-individualized databases and tools, which have, over time, increased costs and increased the administrative burden for both health plans and healthcare providers.

CAQH Twitter Chat Discusses Administrative Savings in Healthcare

April 2017

Are we doing all we can to maximize administrative savings in healthcare? What are the biggest opportunities to cut costs for healthcare providers, health plans and other industry stakeholders? On Feb. 16, CAQH (@CAQH) held a Twitter chat with Health Populi blogger Jane Sarasohn-Kahn (@healthythinker) to discuss the topic.


Voluntary CORE Certification Webinar with Texas Medicaid

Why should a State Medicaid Agency pursue Voluntary CORE Certification for Phases I-III? View this recorded on-demand webinar to learn about CORE Certification and whether it is appropriate for your type of organization. View the recorded webinar.

Use and Adoption of Attachments in Healthcare Administration - Part II

May 4, 2017, 2:00 PM ET

There has been an expressed need for comprehensive and foundational knowledge on the industry use and adoption of attachments in the administration of healthcare. Register for this webinar to receive an overview of electronic claims attachments including the current exchange standards, the anticipated interim rule, and the key challenges and opportunities for stakeholders. Register now.

CAQH on the Road

CAQH will be exhibiting or speaking at the following events:


DecisionHealth, Nashville, TN
April 24
Presentation (4:30 PM): What’s New with CAQH ProView?


Blue Cross Blue Shield Association National Other Party Liability Group, Glendale, AZ
April 25-28 – Visit the CAQH exhibit booth.


National Dental EDI Council EDI Summit, Scottsdale, AZ
May 1-3 (presentation date TBD)
Presentation: Voluntary CORE Certification: The Industry is Moving Forward!


WEDI 2017, Los Angeles, CA
May 16 (time TBD)
Panel Discussion: Navigating the Waters of HIT Certification

New CAQH Staff

Randi Chapman, Director of State Relations

Randi will establish and maintain relationships with state agencies, state health plan and provider associations and other related stakeholders to ensure CAQH is aware of, and understands, state regulatory and legislative activity relevant to its initiatives. She has more than 15 years of government relations experience with executive branch leaders, legislators and external stakeholders. Randi was most recently Director, State Affairs for the Alzheimer’s Association.

Abbie Eastman, Desktop Support Manager

Abbie manages technical support services for CAQH IT and intranet systems. She previously served over twelve years in a variety of roles for the American Red Cross as a Systems Analyst, Product Manager, Manager of IT Application Support and Manager of HR Information Technology Vendor Relations.

Shruti Ghosh, Product Manager

Shruti is the newest member of the product team working to enhance and guide development of CAQH Solutions. Prior to joining CAQH, she was a product strategist and program manager for HCentive, Inc., a benefits management software company, and a healthcare consultant for Deloitte.  

Jaime Gonzalez, Manager, Business Analytics

Jaime is developing a Business Analysis Center of Excellence to enhance analysis and data reporting for CAQH Solutions. He previously managed a team of IT Consultants at Kaiser Permanente and has served as Senior Business Analyst for ValueOptions, a behavioral health maintenance organization.

Sumalatha Gorrela, Senior Business Analyst

Sumalatha has joined the Business Analysis Center of Excellence as a senior analyst. She was previously a Senior Business Analyst at the Universal Service Administrative Company and has held analyst positions at CGI and CareFirst Blue Cross Blue Shield.

Yuvi Kochar, Managing Director, Technology and Operations

Yuvi is responsible for the overall information technology functions for CAQH Solutions, combining strategic leadership and tactical execution on the design and implementation of a comprehensive and evolving suite of solutions and services. Most recently as a consultant, he served as the Interim Chief Information Officer for a large consumer behavior measurement company. Yuvi has held a variety of IT leadership roles, including Vice President IT and Chief Technology Officer for Graham Holdings and Director of Global Delivery for Syntel.

Saravanan “Sean” Regunath, Senior Solutions Architect

Sean works to transform product concepts and requirements into high-level architecture used as the blueprint to build and implement new solutions. Most recently, he led a team at CNSI responsible for a number of healthcare systems and initiatives, including the Medicaid Management Information Systems for Michigan and Washington.

CAQH in the News


CAQH Software Aids Provider Credentialing Efforts – Health Data Management

Medical Coalition Calls for Prior Authorization Reform – Medscape
Free Registration required

My $100 Flu Shot: How Much Paper Waste Costs U.S. Health Care – The Huffington Post

No margin for error: Reduce rejected claims with accurate patient data – Healthcare Business & Technology

Relieving the pain of prior authorization delays – HealthcareIT News

Prior Authorization Still a ‘Pain Point’ for Providers – HealthLeaders Media

From Machine-Readable Provider Directories, A Preview Of A Revolution – Health Affairs Blog

Report reveals that moving to electronic business transactions could save health care $9.4 billion – Dentistry IQ

HIMSS 2017: Prior authorization flaws require collaborative response – HealthExecutive

Using Bundled Payments to Pay Providers for mHealth Nudges – Revenue Cycle Intelligence

Aetna, Cigna Join 300 Organizations in CAQH CORE Phase III – Health Payer Intelligence

CORE certifications top 300 with Aetna and Cigna awards – Health Management Technology