CAQH Initiatives Reduce Medicaid Administrative Burden

September 2018

The ongoing need to reduce administrative expenses in healthcare—while concurrently increasing information accuracy—is at the heart of CAQH activities that benefit the healthcare providers, health plans and agencies that serve Medicaid patients.


Medicaid agencies and health plans have a significant opportunity to save more than $4.8 billion annually by adopting CAQH CORE Operating Rules for electronic transactions as verified by certification. CAQH CORE has developed and issued four phases of operating rules that support standards, accelerate interoperability and simplify administrative activities. Plans covering 44 percent of all Medicaid enrollees have achieved some level of certification.

Check the Medicaid savings opportunity in your state.


CAQH Solutions®

CAQH Solutions help reduce administrative burden for Medicaid agencies and health plans by improving cost avoidance, streamlining provider enrollment and screening, increasing the accuracy of provider directories and more.

CAQH is an NCQA-certified Credentials Verification Organization.

  • COB Smart® offers a market-wide registry of other payer coverage data. The Solution enables Medicaid agencies and health plans to identify patients with multiple forms of other insurance to support payment accuracy for third party liability.

  • CAQH ProView® eases the burden of provider data collection, maintenance and distribution through a multi-state, multi-stakeholder platform used by more than 1.4 million providers. Providers enter their professional and practice data once, and then share it with participating organizations to support provider enrollment, credentialing, directories and other needs for accurate provider data.

  • VeriFide™ streamlines provider data verification by standardizing data elements for plans and using advanced automated technologies that compare provider information against primary sources for accuracy.

        CAQH is an NCQA-certified Credentials Verification Organization.

  • DirectAssure® substantially increases the accuracy of provider directories and reduces the need for direct individual outreach to providers. Integrated into the CAQH ProView workflow for providers, the Solution complies with state and federal requirements.

  • EnrollHub® simplifies enrollment for electronic funds transfer and electronic remittance advice by enabling providers to use a single, secure online process to sign up for electronic payments with multiple plans and state Medicaid agencies.

  • SanctionsTrack® consolidates and electronically reports provider sanctions to participating plans and state Medicaid agencies by continuously scanning more than 500 state licensing boards and federal sources such as SAM and OIG.

Learn more about how CAQH initiatives can streamline Medicaid administrative processes.

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