August 2017

Improving Provider Directory Accuracy in an Evolving Regulatory Landscape

August 2017

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.

Lessons from UnitedHealthcare and DirectAssure on Improving Provider Directory Accuracy

August 2017

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

CAQH ProView Updates Enhance Provider Data and Address Industry Needs

August 2017

CAQH ProView was launched on a new platform in 2015 to enable greater flexibility and growth for the solution. CAQH has been working since the launch to improve the accuracy of the data within the platform, and expand its use in addressing additional, industry-wide provider data needs.

Ongoing system improvements contribute to a timely and accurate exchange of data between providers and health plans. In most cases, CAQH ProView is requesting new information from providers that health plans previously secured through phone outreach, requiring practices to field calls and deliver responses to multiple plans. In other cases, more precise information addresses patients’ need for improved provider directories.

Article in Group Practice Journal Highlights Provider Benefits of CORE Certification

August 2017

A new article in Group Practice Journal describes how providers can take greater advantage of the progress made by the CAQH CORE Operating Rules and Certification Program. Written by Susan L. Turney, M.D., CEO of Marshfield Clinic Health System and Vice-Chair of the CAQH CORE Board, the article emphasizes the importance of the work by CAQH CORE to streamline electronic business transactions and the need for greater industry participation in the certification program.

Turney describes how most providers should now have all of their payers—both public and private—conducting real-time processing of eligibility and benefits verification and claim status inquiries. Payers should also be offering the option to electronically receive payments, among other efficiencies in common business transactions due to CAQH CORE initiatives.

CAQH Index Debuts at Academy Health Annual Research Meeting

August 2017

The 2016 CAQH Index findings were displayed during a Technology and Health poster session at the Academy Health Annual Research Meeting in June. The poster session was part of a three-day annual meeting where more than 2,500 attendees gathered to learn about the latest health services research improving health and healthcare around the globe.

The CAQH Index poster highlighted industry efforts to increase automation of routine healthcare administrative transactions. The 2016 report found that there is more than $11 billion in savings available to medical and dental health plans and providers with greater adoption of electronic transactions.


Save Time and Money! CAQH CORE and OrboGraph Discuss Value of Implementing the Phase III CAQH CORE Operating Rules

August 31, 2017, 2:00-3:00 PM EDT

For organizations interested in faster payment and remittance advice processing, CAQH CORE and OrboGraph will discuss the benefits of going paperless in healthcare financial transactions. This webinar is open to all non-CORE and CORE Participants. Register now.

CAQH CORE Town Hall National Webinar

September 07, 2017, 2:00 – 3:00 PM EDT

CAQH CORE Town Hall webinars provide the public with an update on recent activities related to industry development and implementation of healthcare operating rules. Learn about federally mandated and voluntary CAQH CORE Operating Rules, voluntary CORE Certification, and much more. This call is open to all non-CORE and CORE Participants. Register now.

NDEDIC and CAQH CORE present a dialog with Delta Dental of California: How a Dental Health Plan Has Successfully Implemented the Phase I-II CAQH CORE Operating Rules

September 13, 2017, 2:00 PM EDT

The dental industry has a critical need to electronically share large quantities of data quickly and accurately. This requires technical standards and common busi­ness practices to simplify data sharing among payers, providers and vendors. Industry-driven CAQH CORE Operating Rules support standards, and specify the business actions each party must adhere to for the HIPAA transactions covered by the rules to occur smoothly and reliably. During this webinar, Delta Dental of California will share its CORE Phase I-II Certification journey, so other dental plans can learn how to maximize the efficiencies of electronic healthcare transactions. Register now.

CAQH on the Road

CAQH will be exhibiting or speaking at the following events:


New England States Consortium Systems Organization Medicaid Enterprise Systems Conference
August 15-18, Baltimore, MD

Stop by exhibit booth #45 to meet CAQH staff from Solutions and CAQH CORE to learn how CAQH initiatives are enabling Medicaid programs to reduce costs and deliver more efficient healthcare services.


Healthcare Billing and Management Association Healthcare Revenue Cycle Conference
September 14-16, Phoenix Arizona

CAQH CORE staff will present on September 14 (5:00-6:00 p.m.) on operating rules for EFT/ERA transactions that improve the efficiency of healthcare payments and reduce denied claims.


National Association of Dental Plans 2017 Conference
September 25-28, Atlanta, GA

CAQH staff will be exhibiting (booth #210) during the National Association of Dental Plans annual conference and will present on September 27 (3:15-4:15 p.m.) on strategies for improving provider data quality for credentialing and directory accuracy.


September 24-27, Dallas, TX

On September 27 from 11:00 a.m. – 12:00 p.m., CAQH staff will host a session for CAQH ProView users at the fall national provider enrollment workshop. The session will address frequently asked questions and offer advice on how to avoid common errors when completing a CAQH ProView application.


New CAQH Staff


Abiola (Abby) Oyem, Business Analyst

Abby joins the Business Analysis Center of Excellence where she will focus on CAQH Solutions, including CAQH ProView and DirectAssure. Previously, Abby held positions as a business analyst at Stack IT Solutions and as a financial system analyst for LifeBridge Health.


CAQH in the News


Reinventing Claims Management for the Value-Based Era – Healthcare Informatics

The 7 Must Have Features of a Practice Management System – Physicians Practice

Reinventing Claims Management for the Value-Based Era – HealthLeaders

5 Steps to Selecting a Practice Management System – Physicians Practice

Washington-area appointments and promotions – Cynthia West, CAQH – The Washington Post

People on the Move – Washington Business Journal

Are We Asking Providers the Wrong Questions? - #HCBiz

ONC, CMS execs participate in Provider Data Action Alliance – Becker’s Hospital Review

Informatics Take Over at the Office of the National Coordinator –

ONC, CMS to Take Part in Provider Data Accuracy Alliance –

Inaccurate data on providers continues to dog payers – Health Data Management

A review of electronic prior authorization technology –