December 2017

CAQH Recognized for Excellence in Health IT by WEDI

December 2017

CAQH, a nonprofit alliance of health plans and related associations, recently received the “Excellence in Health IT Award” from the Workgroup for Electronic Data Interchange (WEDI). Presented during the WEDI annual meeting on December 6, the award recognizes organizations and individuals that have made outstanding contributions to the advancement of information technology (HIT) and eCommerce technology in healthcare.

Phase IV CAQH CORE Certification Opens for Prior Authorization and Other Electronic Transactions

December 2017

Organizations can now become CORE-certified in the Phase IV operating rules for exchanging administrative data electronically. The rules help streamline prior authorization, healthcare claims, employee premium payments, health plan enrollment and disenrollment, and other transactions.

Making it Easier for Providers to Enroll in Electronic Payments

December 2017

CAQH has reduced the number of steps it takes for healthcare providers to enroll in electronic funds transfer (EFT) with payers. Now, in just two clicks—in less than one minute—providers already registered with EnrollHub can sign up to receive electronic payments with additional payers. Previously, providers were required to log into the system, access their account and request enrollment with those payers.

Health Plan Strategies to Improve Directory Accuracy

December 2017

Improving provider directory accuracy continues to be an industry-wide challenge. Periodic reviews from the Centers for Medicare and Medicaid Services (CMS) have intensified pressure on health plans to improve the quality of directories. Plans allocate significant resources to these efforts, which are a portion of the $2 billion spent annually by the commercial healthcare industry to maintain provider data.

2017 CAQH Index Findings to be Announced in Upcoming Webinar

December 2017

There is widespread consensus that administrative costs in healthcare are excessive. By some estimates, more than $300 billion each year is spent conducting basic business transactions between healthcare providers and health plans. Much of this expense can be attributed to resource-intensive manual processes, such as phone calls to verify patient coverage or mailing claims and paper checks. 

Each year, CAQH collects data from health plans and providers on the shift from manual to electronic business transactions. The findings are compiled in the CAQH Index, the industry source on trends in adoption rates and cost savings associated with automation.

Other News

Phase IV CORE Certification Pioneers: Panel Discussion with Humana, PokitDok and WorkComp EDI

December 20, 2017 | 2:00 PM to 3:00 PM EST

Join CAQH for a panel discussion with Humana, PokitDok and WorkComp EDI, three of the organizations to complete Phase IV CORE Certification. The Phase IV CAQH CORE Operating Rules address electronic transactions for healthcare claims, prior authorization, enrollment or disenrollment in a health plan and premium payments. Conformance with the rules means that providers will know in real-time if healthcare claims and requests for prior authorization were received by the health plan and are under review, among many other benefits.

The Panel will discuss why they decided to pursue Phase IV CORE Certification, any challenges they encountered during the CORE Certification process, as well as the value and efficiencies they anticipate from implementation.



Implementing Successful Value-based Payment: Alternative Payment Models with CMMI

January 11, 2018 | 2:00 PM to 3:00 PM EST

Emerging value-based payment (VBP) models are critically important in meeting future needs for improving the quality and cost of healthcare. This webinar will feature Laura Sessums, M.D., from the Center for Medicare and Medicaid Innovation (CMMI) Seamless Care Models Group. Dr. Sessums will discuss how practices are working in Comprehensive Primary Care Plus, a national primary care medical home model. This webinar is the second in an ongoing educational series from CAQH CORE to address operational challenges inherent in the transition to VBP. 



Use and Adoption of Attachments in Healthcare Administration, Part IV: Clinical Document Architecture Basics – Clinical Content

January 18, 2018 | 2:00 PM to 3:30 PM EST

Providers want to improve their ability to electronically submit additional documentation to support the adjudication of claims, prior authorization, audits and other needs. One way to save time and improve efficiencies is to transmit these attachments electronically. Webinar attendees will learn how efficient use of an electronic attachment can reduce administrative burden, understand the clinical document metadata for attachments and get an overview of future attachment standard frameworks. This is the fourth webinar in a series and will be a technical training for an intermediate or advanced audience.

Register and access Parts I-III.


CAQH on the Road


CAQH will be exhibiting or speaking at the following events:


Strategic Solutions Network 11th Healthcare Payments Innovations
January 22-23, 2018, Phoenix, AZ

Robert Bowman, a CAQH CORE Director, will discuss how to improve revenue cycle performance with operating rules for healthcare transactions on January 22 at 5:20 PM. The conference will explore topics including next generation payment models and financial performance and transparency.


2018 American Academy of Dental Group Practice Expo
January 31 – February 3, 2018, Las Vegas, NV

Join CAQH at the American Dental Association booth (ADA) to learn how the ADA and CAQH are simplifying the credentialing process for dentists. CAQH staff will be present to answer questions and demo the new ADA credentialing service, powered by CAQH ProView.


National Credentialing Forum 2018
February 1-2, 2018, San Diego, CA

Sorin Davis, Managing Director, Industry Relations, will provide a CAQH update at the National Credentialing Forum on February 1 at 3:15 PM. Each year the forum brings together organizations and individuals interested in credentials verification for health care professionals to share information.


New CAQH Staff


Kyra Newman, CORE Associate, Education and Outreach

Kyra will assist with the development of new resources to educate stakeholders about CAQH CORE initiatives. Kyra has a background in social work and has developed and led numerous training programs for mental health nonprofits.

Michael Rabhan, Senior Manager, Business Development

Michael Rabhan is promoting CAQH solutions to the southeast region. He has twenty years of sales experience with more than a decade in the healthcare and dental markets, most recently with P&R Dental Strategies.  

Kelly Rose, Sales Operations Manager 

Kelly is responsible for all sales operations functions at CAQH. Prior to joining CAQH, she was a project manager and consultant at TechnoMile. Kelly has more than seven years of operations and Customer Relationship Management (CRM) experience. 

Mangai Thiagarajan, Senior Technology Manager

Mangai works on CAQH ProView and DirectAssure. She began her career as a programmer and since then has held positions in solutions architecture, project implementation, product development and operations management. 


CAQH in the News


CAQH CORE Opens Certification for Electronic Prior Authorization, RevCycleIntelligence

WEDI announces 24 annual award winners, Becker’s Hospital Review

CAQH CORE Opens Phase IV Certification for Prior Authorization and Other Electronic Healthcare Transactions, Healthcare Dive

HHS announces pilot project on optimizing administrative simplification standards, AHA News

HHS Pilot Encourages Streamlined Health Plan HIPAA Compliance, Health Payer Intelligence

Streamlining the Business of Healthcare: Why Industry Must Lead the Way, HealthLeaders

ADA Partners with CAQH to Streamline Credentialing, Dentistry Today

More than 1 Million Federal Employees Now Covered by CAQH CORE-Certified FEHB Plans, Business Insider

Zocdoc appointment booking app now verifies insurance with AI, Healthcare Finance News

ADA Collaboration seeks to help streamline credentialing process for dentists, Emmot on

Health care billers that don’t shed paper will pay a price, Payments Source

TIBCO BusinessConnect Supports Real-time Healthcare Transactions, TIBCO Software, Inc.