October 2019

Deadline Extended: Exchanging Medical Documentation Survey

Responses due by Friday, November 1, at 5 p.m. PT

October 2019

CAQH CORE is seeking participants for its survey on the exchange of medical documentation, also known as “attachments.” Since no federally mandated standard for sharing electronic attachments exists, the goal of the survey is to better understand how they are currently exchanged. The findings will help inform the development of operating rules to support a more standardized workflow.

Industry Progress on Improving Prior Authorizations

In a recent Medium post, Rachel Goldstein, Senior Manager at CAQH CORE, takes a look at the history of prior authorization and how we can move forward.

October 2019

A standard electronic method for conducting at least a portion of the prior authorization process has been federally mandated since the early 2000s. However, nearly 20 years later, 88 percent of prior authorizations are still conducted either partially or entirely manually, using faxes and phone calls to request and provide clinical information. When managed this way, prior authorizations can take hours, days and even weeks — leaving patients in limbo.

Presentation Showcases How Medicaid Plans Can Improve Coordination of Benefits

With 13 percent of beneficiaries reporting that they have additional coverage, the coordination of benefits process for Medicaid plans can be complicated and costly.

October 2019

CAQH estimates that administrative inefficiencies associated with coordination of benefits cost the industry $800 million each year. At the Medicaid Health Plans of America (MHPA) Annual Conference, Morgan Tackett, Senior Product Manager of COB Smart, and Laura Carraway, Senior Vice President of Cost Optimization-Program Integrity Coordination of Benefits at Anthem, shared recommendations for how to make this process more efficient and accurate.  

Industry Collaboration Improves Provider Directories

A coordinated approach to provider data management fosters data accuracy and adds efficiency to healthcare administration.

October 2019

Members expect their health plan to deliver reliable and accurate provider information so they can find the care they need. Yet maintaining up-to-date, high-quality provider directories is challenging. About half of all provider location listings have at least one inaccuracy, according to the Centers for Medicare and Medicaid Services (CMS).

Dental Market Expansion

Even as many dentists retire, a greater number of dental providers are continuing to enter the field.

October 2019

Today, more dentists are practicing each year as the U.S. dental industry is growing1. According to the Health Policy Institute (HPI), the number of practicing dentists is expected to increase between 2.6 and 4.5 percent between 2017 and 20372.

The increase in dentists is a positive change for consumers, who need a larger dental population to serve what the American Dental Association (ADA) has identified as a steady increase in demand for dental services. However, the rapid growth of this market also means an influx of dental provider data to manage.