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.

VeriFide employs advanced technology to integrate seamlessly with CAQH ProView, which contains self-reported professional data from more than 1.4 million healthcare providers. The solution further automates the verification process by integrating with most primary data sources. This elimination of manual processes both reduces the time required for verification and reduces the likelihood of human error. CAQH estimates that VeriFide will return 98 percent of initial provider files within 14 days, with an accuracy and completeness rate of 98.5 percent. 

The solution was developed in concert with credentialing experts from a number of health plans. Early in 2016, CAQH achieved NCQA-certification as a Credentials Verification Organization (CVO), a critical qualification. Once developed, VeriFide was piloted by CAQH member plans including Aetna, Blue Cross Blue Shield of Michigan, CareFirst BlueCross BlueShield and Health Net. CAQH is confident that VeriFide will achieve broad participation by health plans, enabling the industry to benefit from this shared verification process.

Over time, VeriFide will enable plans to share common, validated information for the providers in their networks, reducing administrative costs by eliminating the need for each plan to manage its own data verification process. The solution will also reduce the administrative burden on providers by decreasing the repetitive requests from multiple plans seeking the same information.

To achieve the goal of industry-wide sharing of validated provider data and the related cost benefits, the credentialing dates of healthcare providers need to be aligned across health plans. Currently, each plan credentials providers on its own unique three-year cycle. Using a sophisticated scheduling algorithm, VeriFide will make gradual changes to provider credentialing dates over time to reach this shared provider “anchor date.” This ensures health plan operations experience little disruption during this transition.

“We believe this initiative will be a game-changer for the industry. There is no business reason for each health plan to verify the same data for the same providers,” said Bruce Edwards, Senior Vice President, Networks Management, CareFirst BlueCross BlueShield. “In addition to reducing business expenses, VeriFide will improve the synergy between providers and payers for the credentialing process.”

To learn more about this new initiative, visit www.caqhverifide.org.

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