September 2018

Massachusetts Health Plans Select DirectAssure to Improve Provider Directory Accuracy

September 2018

HealthCare Administrative Solutions (HCAS), a non-profit organization of Massachusetts-based health plans, has chosen DirectAssure® after an extensive search for a solution to improve healthcare provider directories in the state.

With DirectAssure, providers enter their directory information changes once and share them with multiple plans. The solution works in concert with CAQH ProView®, an online database used by more than 1.4 million providers nationwide to maintain their professional and practice information. DirectAssure asks providers to compare and verify practice location information within health plan records and confirm whether they accept specific insurance plans and if they are accepting new patients.

CAQH CORE Backs Industry Collaboration to Improve Prior Authorization Process

September 2018

Last month, the CAQH CORE Board submitted an open letter in support of the Consensus Statement on Improving the Prior Authorization Process, which shares many CAQH CORE goals, such as improved transparency and communications, continuity of patient care and automation and efficiency.

Committed to collaborating with industry stakeholders, CAQH CORE is eager to work with the statement’s authoring organizations, which include the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA).

The 2017 CAQH Index found that healthcare provider and health plan adoption of standard prior authorization transactions was only eight percent--one of the lowest adoption rates of all transactions measured in the report. The proportion of prior authorization transactions conducted using that standard actually declined by more than 10 percentage points in comparison to the 2016 CAQH Index. However, automating prior authorization could result in savings of $6.84 per transaction.

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.

Upcoming Webinars


Prior Authorization Industry Landscape

September 25, 2018 | 3:00 PM – 4:00 PM EDT

The webinar will present industry activities to respond to the challenges of the inefficient prior authorization process, specifically the Consensus Statement on Improving Prior Authorization and related initiatives, WEDI PA efforts and CAQH CORE operating rule development.  



How CAQH ProView for Groups is Transforming the Way Amerigroup Tennessee Manages Delegated Data

October 3, 2018 | 1:00 PM – 2:00 PM EDT

CAQH ProView for Groups is a major enhancement to CAQH ProView that streamlines data sharing between health plans and delegated groups, resulting in better quality data with less manual effort. In this webinar, you will learn why Amerigroup Tennessee chose to partner with CAQH, their process for implementing CAQH ProView for Groups, the benefits Amerigroup Tennessee has already experienced and how delegated groups are using the tool.



Recent Webinars – Recordings Available


Value-based Payment Webinar Series: Quality Measures – Benefits and Challenges to Improving Patient Care

Quality measures help assess the performance of the healthcare system and form the basis of performance targets to which payments are tied. Data on quality measures are collected or reported in a variety of ways, including: claims, assessment instruments, medical records and registries. Learn how the industry is defining quality measures and setting up payment systems based on them through real world adoption examples from an industry leading expert.

Watch the on-demand webinar recording here.


Proven Tactics for Improving Your Provider Credentialing Process: A Blue Cross and Blue Shield of Alabama Case Study

Costly data acquisition fees and human entry errors, incomplete files, manual processes, and provider abrasion are a few reasons why Blue Cross and Blue Shield of Alabama (BCBSAL) explored opportunities to improve their provider [re]credentialing, primary source verification and sanctions monitoring process. 
With the Credentialing Suite by CAQH, the BCBSAL team significantly reduced its provider outreach and credentialing cycle from 120 days to 60 days, improved data quality, ensured consistent data queries and evaluation for sanctions tracking, and streamlined internal processes to improve the overall cost.
Watch the on-demand webinar recording here.


Making the Business Case for Automation

Explore opportunities to integrate health plan functions with CAQH Solutions to enable cost savings, increase quality and accuracy, and speed provider on-boarding. 

Representatives from BlueCross BlueShield of Tennessee (BCBSTN) and CareFirst BlueCross BlueShield discuss their health plan experiences automating enrollment and primary source verification (PSV) automation, including:

  • Why BCBSTN decided to integrate their provider enrollment process with CAQH, their approach and lessons learned, and immediate improvements to key process indicators.
  • How CareFirst, a customer of VeriFide, launched a project to automate the intake of VeriFide PSV outputs, how it changed their processes, and their goals for turnaround time and automation.

Watch the on-demand webinar recording here.



New Employees


Jimmy Bucklen, Senior Manager, Technology

Jimmy is assigned to CAQH ProView as a new member of the Technology team. He has more than 20 years of experience in software development with 15 years in the healthcare industry. In his most recent role as Director of Solutions Architecture at Centene, Jimmy managed a team of software architects and oversaw design and integration for products and systems that benefited millions of members.


Kamran Hassan, Manager, Provider Engagement

A new member of the Marketing and Communications team, Kamran is conducting outreach to engage targeted delegated provider groups. He joins CAQH from MedStar Health, where he oversaw operations at two multi-specialty medical centers.


Kate Meyer, Manager, Communications

In the media relations role, Kate is responsible for drafting media materials and other content, developing relationships with trade media and securing interview opportunities to raise the profile of CAQH. She previously worked as the Health Communications Manager at Planned Parenthood of America.


Mark Pratt, Senior Vice President, Public Affairs

Mark is responsible for leading state and federal government relations, policy development and regulatory affairs to advance CAQH interests in the public policy arena. Mark joins CAQH with more than 20 years of experience in public policy, healthcare and insurance regulation. The former Senior Vice President of State Affairs for America’s Health Insurance Plans, Mark has served as an advisor to CAQH for almost two years, helping to establish the state relations function.


Christopher Swartz, Senior Product Analyst

Christopher is collaborating with CAQH product managers on CAQH ProView, specifically data quality. He previously worked at Greenway Health in both product and implementation roles during his time there. He holds certifications as a Certified Scrum Product Owner and in Pragmatic Marketing.


CAQH On the Road


DecisionHealth Fall National Provider Enrollment Workshop

September 16 – 19 | Nashville, TN

On September 17, from 1:30 – 3:00 p.m., CAQH Product Manager Hassaan Sohail will present on CAQH ProView, including how to prepare for new attestation requirements and how to avoid common errors when completing an application.


Information Management Symposium

September 23 – 26 | Birmingham, AL

Visit us at booth #112 to learn about CAQH provider data management solutions.

Learn about "Data Science and Machine Learning for Provider Data" on Tuesday, September 25 from 9:45 - 10:30 a.m. The session will feature presenters Atul Pathiyal, Senior Vice President of Product and Strategy at CAQH; and Ben Holliday, Director of Provider Data Management at BlueCross BlueShield of Tennessee. 


NADP Converge

September 24 – 27 | Denver, CO

Stop by booth #34 to learn about how CAQH initiatives can help dental plans go electronic.

Reid Kiser, lead researcher on the 2017 CAQH Index, and Taha Anjarwalla, Manager of CAQH CORE, will give a presentation on Electronic Transactions - Trends in Adoption Rates and Cost Savings on Wednesday, September 26th from 2:00 - 3:00 p.m.


MGMA Annual Conference

September 30 – October 3 | Boston, MA

CAQH experts will be posted at booth #1918 to answer all practice manager questions related to CAQH ProView.


Xtelligent Media Value-Based Care Summit

October 17 – 19 | Boston, MA

Erin Richter Weber, Director of CAQH CORE, will present research on value-based payments in a session on Wednesday, October 17 from 2:00 - 2:45 p.m. The session will focus on the report “All Together Now: Applying the Lessons of Fee-for-Service to Streamline Adoption of Value-Based Payments” that CAQH CORE published earlier this year.


Medicaid Managed Care Annual Conference

October 21 – 23 | Washington, D.C.

Visit booth #7 to learn about how CAQH Solutions can help streamline Medicaid administrative processes.


California Association of Health Plans Annual Conference

October 22 – 24 | San Diego, CA

CAQH staff will be stationed at booth #414 ready to talk about the business of healthcare.


CAQH “In the News” Highlights


Prior Authorization Process Needs Overhaul, Say Major Health Care Organizations, Managed Care Online

CAQH CORE Aligns with Push to Boost Prior Authorization, Health Data Management Online

CAQH CORE Urges Industry Collaboration on Prior Authorizations, Health Payer Intelligence

Senators Weigh Effects of Prior Authorization on Administrative Costs, Inside Health Policy

Want to Rid Healthcare of Fax Machines? First, Standardize Prior Authorization, Healthcare Finance News Online

The Cost Savings Opportunities on the Business Side of Healthcare, EMR & HIPAA

Medicaid Could Save $4.8B Through Electronic Claims Management, RevCycle Intelligence

Prior Authorization Moves to EHRs, Healthcare Dive

Moving to Electronic Transactions Could Save Medicaid Plans Over $4.8B Annually, Healthcare Dive