March 2018

CAQH CORE Report Highlights Ways to Streamline Value-based Payment Operations

March 2018

The U.S. healthcare economy is undergoing a transformation in how care is measured, billed and paid. Organizations around the country are shifting away from fee-for-service models that reimburse providers for the volume of care, and experimenting with value-based payment models, which align quality of care and cost controls with provider compensation. As value-based payment innovation continues, there are many threats to its progress, such as operational challenges.

Data Quality Improves with DirectAssure Enhancements

March 2018

In its second year of adoption, DirectAssure has established itself as a leading solution for health plans to address the ongoing challenge of maintaining accurate provider directories. Making changes to directory information is seamless for healthcare providers, who use CAQH ProView to easily review and update their professional information. DirectAssure participating organizations, including most national plans, are already using the solution to manage directory data for more than 800,000 providers. On average, about 600,000 of those providers review and confirm their information every four months, demonstrating a high level of engagement with CAQH.

CAQH ProView Provider Data Solutions Conference for Health and Dental Plans

March 2018

This May, CAQH is hosting a conference in Washington, DC for health and dental plan managers responsible for provider data, including CAQH ProView administrators. The conference will offer helpful insights for improving provider credentialing, directories and data quality. Attendees will discover how to leverage CAQH Solutions across departments, talk to “power users” about overcoming provider data challenges, preview upcoming enhancements, meet the CAQH Product team, network with peers and more. Contact your CAQH ProView account manager to learn more about this event.

COB Smart Forum Keynote Outlines NAIC Coordination of Benefits Regulation

March 2018

In late February, CAQH hosted COB Smart Connection: A Forum for Participating Organizations. The keynote speaker was Jolie H. Matthews, Senior Health and Life Policy Counsel at the National Association of Insurance Commissioners (NAIC). Created in 1871, the NAIC is a nationwide organization that establishes standards to improve the state regulation of insurance, including health and dental.

Other News

New CAQH CORE Report: All Together Now - Applying the Lessons of Fee-for-Service to Streamline Adoption of Value-based Payments

Guest Speaker: Dr. Susan Turney, FACP, CEO of Marshfield Clinic Health System
April 10, 2018 | 1:00 PM to 2:00 PM ET

Join guest speaker Dr. Susan Turney, CEO of Marshfield Clinic Health System, who will introduce a new report from CAQH CORE on industry opportunities to streamline value-based payment operations. Dr. Turney will also share her thoughts on how by collaborating now, before proprietary systems and processes become entrenched, the industry can ensure that innovative payment models are unimpeded by administrative hassles.



CAQH CORE Town Hall National Webinar

May 10, 2018 | 2:00 PM to 3:00 PM ET

CAQH CORE Town Hall webinars provide the public with an update on recent CAQH CORE activities related to industry development and/or implementation of healthcare operating rules. Learn about federally mandated and voluntary CAQH CORE Operating Rules, voluntary CORE Certification, and much more.



CAQH on the Road


CAQH will be exhibiting or speaking at the following events:


Ohio State Medical Association Annual Meeting
April 13-15, 2018, Columbus, OH

Join CAQH at the Ohio State Medical Association Annual Meeting to see upcoming enhancements to CAQH ProView and the importance of providing accurate directory listings.


National Other Party Liability Group Conference 
April 17-20, 2018, Scottsdale, AZ

CAQH will be exhibiting at NOPLG. Stop by the booth to learn about how your health plan can better facilitate the coordination of benefits process with COB Smart.


America’s Physician Groups Annual Conference 2018
April 19-21, 2018, San Diego, CA

Visit the CAQH booth to learn about upcoming CAQH ProView enhancements and CAQH CORE research on value-based payments.


NDEDIC Summit 2018
April 30 – May 2, 2018, Austin, TX

CAQH CORE will be presenting on the CAQH Index®  and the value of CAQH CORE Operating Rules to the dental industry. Check out the presentation on Day 2 of the NDEDIC Summit from 1:30 – 3:00 p.m.


New CAQH Staff


Derica Smith, CORE Associate

Derica is supporting CAQH CORE with rule development and maintenance efforts, including prior authorization and code combinations. She spent nearly six years working at the Florida Agency for Health Care Administration and more recently with the National Academy for State Health Policy. She has a Master of Public Health with a concentration in Health Policy and Management.

BJ Taylor, Account Manager

BJ, the newest member of the CAQH Account Management team, manages relationships with multiple participating organizations to help navigate industry changes and ensure they can take full advantage of CAQH Solutions. He has over 18+ years of experience in healthcare information/account management and was recently an Account Executive with AIS Health.


CAQH in the News


RCM tip of the day: Automate CAQH re-attestation processes, Becker’s Hospital CFO Report

Q&A with the ADA by Dr. Thomas Giacobbi, Dentaltown

Overcoming Common Obstacles of Transitioning to Electronic Insurer-to-Provider Payments, HFMA

The 'Intelligent' 278: Creating a Standard for Shared Decision Support, Healthcare IT News

The Blockchain Will See You Now, Hill and Knowlton Strategies

When & Why to Hire a Practice Director, Review of Optometric Business

Automating prior authorization process to save provider time, Becker’s Health IT and CIO Review

Is Medical Billing for You?, Dentaltown

Choosing the Right Payment Mix for your Practice, Health IT Outcomes

65 RCM Tips from 2017, Becker’s Hospital CFO Report