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.

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 sales@caqh.org.

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.

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.

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.