October 2017

CAQH Teams with the American Dental Association (ADA) to Simplify Credentialing Process for Dentists

October 2017

In an effort to reduce administrative burdens for all dentists, the ADA and CAQH have formed a strategic alliance to help streamline the credentialing process for dentists, dental plans and employers. The ADA® credentialing service, powered by CAQH ProView®, enables dentists to enter their professional and practice information one time in an easy-to-use, fast and protected digital platform.

ADA is widely promoting this service to all U.S. practicing dentists, including its membership of 161,000 dentists. The number of dentists participating in CAQH ProView is expected to increase substantially, making it the leading industry source for dentists’ credentialing data.

Open for Industry Review: Roadmap to Improve Accuracy of Provider Data

October 2017

What will it take to achieve consistent, high-quality healthcare provider data for industry stakeholders and patients?

From paying a claim to developing a provider directory, accurate, timely and complete provider data is necessary to conduct business in healthcare. However, efforts to collect provider data are still conducted using a piecemeal approach. Redundant and time-consuming tasks cost the commercial healthcare industry an estimated $2.1 billion annually.

New On-Demand Webinar: Keys to Improving Your Credentialing Process

October 2017

The credentialing verification process in healthcare can be inefficient. Health plans often use manual processes to verify provider information, which can lead to errors and incomplete files. Delays in the process also contribute to long lead times before a provider can join a new network.

Opportunities to lower costs and increase file accuracy are a few reasons why health plans are exploring ways to improve their provider credentialing process and reduce administrative burdens.

CAQH CORE Issue Brief: Why the Industry Needs to Lead the Way in Streamlining Healthcare Business Transactions

October 2017

The healthcare economy is going digital. However, a minimum of 1.1 million labor hours of manual administrative work goes into conducting basic transactions each week. For example, up to 40 percent of claim payments and remittance advices, are still done the old-fashioned way—by hand.

The financial services industry offers an interesting comparison. Today, consumers enjoy automated cash withdrawals, global banking and routine streamlined transactions. While healthcare is a more complex industry with many more stakeholders, there are lessons that can be applied from the banking world.


CAQH SOLUTIONS WEBINAR: A 360° View of Cigna-HealthSpring Strategies for Improving Provider Directories

October 26, 2017 ,12:00 PM to 01:00 PM EDT 

Understanding the foundational elements and administrative processes needed to improve your health plan's provider directories is an essential first step to more accurate, timely data. Join Krista Lehm, Director, Delivery System Support at Cigna-HealthSpring and Ron Urwongse, Senior Product Manager at CAQH for a detailed discussion on:

  • Reducing the directory errors deemed most critical by CMS and state regulators.
  • Successfully engaging providers to update their practice data.
  • Creating actionable policies for your plan to improve data monitoring.


CAQH CORE WEBINAR: Use and Adoption of Attachments in Healthcare Administration Part III: Clinical Document Metadata for Attachments

November 02, 2017, 02:00 PM to 03:30 PM EDT

There is 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 learn about the Clinical Document Metadata for Attachments (CDA). The webinar will also review the C-CDA/Meaningful Use requirements, among other related topics. This is the third webinar in the series on attachments and is intended as a technical training for intermediate and advanced audiences. Recordings and slide decks for Part I and Part II are available. Register.

CAQH CORE WEBINAR: Data Needs for Successful Value-based Care Outcomes

November 20, 2017, 02:00 PM to 03:00 PM EST

Emerging value-based payment (VBP) models are critically important to improving the quality and cost of healthcare. The national movement away from fee-for-service (FFS) to VBP is a massive undertaking, and one of the operational challenges inherent in the transition is appropriate use of clinical and administrative data. Guest speaker, Steven Waldren, M.D., Director of the American Academy of Family Physician’s Center for Health IT, will discuss the existing challenges as well as the operational capabilities needed to ensure accurate and reliable data for a VBP system. Register.

Did You Miss our #HITsm Twitter Chat on Provider Data?

CAQH hosted a recent #HITsm Twitter chat on the role of provider engagement in improving data accuracy. The chat covered topics on how collaboration and enhanced communication can ease the burdens on providers and users of provider data. Read the transcript


CAQH on the Road


CAQH will be exhibiting or speaking at the following events:


CBI Electronic Benefit Verification and Prior Authorization Summit
October 24-25, San Francisco, CA

Robert Bowman, CAQH CORE Director, will present on October 24 at 4:45 p.m. on CAQH CORE and its recent work to enhance electronic prior authorization for the healthcare industry.


Medicaid Managed Care Annual Conference
October 29-31, Washington, D.C.

Atul Pathiyal will discuss provider data accuracy in a presentation with Krista Lehm from Cigna-Health Spring. 


New CAQH Staff


Eric Bravo, Operations Support Specialist

Eric provides operations support for CAQH Solutions, including EnrollHub and COB Smart. He recently completed his graduate degree at American University in Public Affairs.

Anil Das, Senior Technology Manager

Anil will be responsible for architectural improvements, feature design, implementation oversight and vendor management for COB Smart. Prior to joining CAQH, he was a technical manager for Abila, a developer of association management software. Anil has more than two decades of experience in the software development industry building, delivering and integrating application software.

Mahender Kalashikam, Product Manager

Mahender is a product manager for CAQH ProView and SanctionsTrack. Prior to joining CAQH, he was a product manager at comScore for Ad Metrix and a lead analyst at Cognizant.

Charles (Chas) Kelley, Project Manager, Solutions 

Chas will be leading cross-department projects for CAQH Solutions. He has more than 20 years of IT project management experience in the financial services, education, medical and software industries. He joins CAQH from CNL Software where he was a program manager.

Hanna Wassihun, Business Analyst

Hanna is a business analyst for CAQH ProView and EnrollHub. Previously, she held positions at Booz Allen Hamilton, CareFirst and the American Red Cross  


CAQH in the News


Paper is Hurting all Healthcare Stakeholders, The American Journal of Managed Care

Cigna, BCBS plans & more to participate in ADA's streamlined credentialing process, Becker’s Dental + DSO Review

ADA collaboration seeks to help streamline credentialing process for dentists, ADA News

CAQH lays out gradual changes to efficiency, flexibility and standardization of provider data, Fierce Healthcare  

CAQH Seeks Stakeholder Feedback on Provider Data Roadmap, EHR Intelligence

Physicians protected from health plan credit card fees, AMA Wire                   

HHS withdraws three proposed rules, including drug payment model, AHA News 

Revenue Leakage in Hospitals and Health Systems: 10 Numbers You Absolutely Must Know, RCM Answers

Leading by Following the Rules, Availity Blog

EFT Flaws, Paper Enrollment Key Electronic Claims Management Issues, RevCycleIntelligence

17% of Practices Pay Fees for Electronic Healthcare Payments, RevCycleIntelligence

1 in 6 practices paying fees for receiving electronic payments, Health Exec 

MGMA: One in Six Practices Pay Fees for Electronic Payments, Medscape

CAQH CORE Compliance: The Voluntary Mandate That Isn’t, HFM Magazine

4 Ways to Improve Payer-Provider Data Management, Health IT Outcomes

Stopping Revenue Leakage – A Quick Start Guide, RCM Answers

The slow uptake of the EFT/ERA mandate matters, Becker’s Hospital Review

Clampdown on network directories fueling online solutions, Healthcare Dive

Why Manual Processes Are a Barrier To Payer-Provider Collaboration, Health IT Outcomes