CAQH Press Releases | Affordable Quality Health Care Press | News

CAQH CORE Operating Rules Adopted By HHS For Patient Eligibility
And Health Claim Status Transactions

Rules to Ensure Electronic Data Transactions are More Predictable and Consistent 

WASHINGTON, DC -

CAQH® announced that the Department of Health and Human Services (HHS) adopted the use of many of the CAQH Committee on Operating Rules for Information Exchange® (CORE®) operating rules regarding eligibility for a health plan and healthcare claim status transactions.  All HIPAA covered entities will be required to comply with these operating rules, which will make electronic healthcare transactions more predictable and consistent, by January 1, 2013 as part of the Patient Protection and Affordable Care Act (ACA). 

CAQH Receives WEDI Leadership in Technology Award

WASHINGTON, DC -

 CAQH was recognized today by the Workgroup for Electronic Data Interchange (WEDI) for its leadership in initiatives that have led to the advancement of electronic delivery of information and eCommerce technology in healthcare.

The WEDI Leadership in Technology Award honors achievements that contribute significantly to the progression of the WEDI mission and was accepted by Robin Thomashauer, Executive Director of CAQH, during the WEDI Fall Conference held in Baltimore. The National Committee on Vital and Health Statistics (NCVHS) was also presented with the award.

Initiative to Support Adoption of Electronic Transactions Encourages Cost Saving Efforts

WASHINGTON, DC -

CAQH and Emdeon Inc. (NYSE: EM) today announced that they have reached an agreement for Emdeon to transfer ownership and management of the U.S. Healthcare Efficiency Index® (USHEI) to CAQH.

CAQH Administrative Efficiency Efforts Acknowledged in Health Affairs Study
that Concludes U.S. Physicians Spend Four Times as Much Money as
Canadians When Interacting with Payers

WASHINGTON, DC -

 CAQH® efforts to simplify healthcare administration have been recognized in a study published in the August 2011 issue of Health Affairs, “U.S. Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers,” written by Dante Morra, et al.

NCPDP and CAQH CORE Partner on Harmonizing Operating Rules and Standards Across Healthcare

SCOTTSDALE, AZ and WASHINGTON, DC -

The National Council for Prescription Drug Programs(NCPDP) and CAQH CORE® (Committee on Operating Rules for Information Exchange®) today announced a partnership agreement to collaborate on activities related to harmonizing electronic data interchange standards and operating rules across the healthcare industry.

Edifecs Launches Updated Testing Platform for CAQH CORE Certification

CORE Operating Rules Work in Unison with HIPAA Version 5010 Standards

Washington, D.C. and Bellevue, Wash. -

CAQH® and EdifecsTM today announced the launch of an updated online platform for certifying conformance with the Committee on Operating Rules for Information Exchange®(CORE®) operating rules. Edifecs, a CORE-authorized testing vendor, is providing the updated testing platform which supports the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transactions and associated errata (v5010).

TennCare Contracts with CAQH UPD to Collect Provider Data

Use of UPD could serve as model for other Medicaid programs

WASHINGTON, DC -

CAQH® announced today that TennCare, the Tennessee Medicaid program, has contracted with CAQH to use the Universal Provider Datasource® (UPD®) to collect healthcare provider data for credentialing. TennCare will also use UPD SanctionsTrackTM, to monitor comprehensive sanctions and disciplinary actions data for its healthcare professionals. TennCare is one of the oldest Medicaid managed care programs in the country and one of two programs that enrolls the entire state Medicaid population in managed care.

900,000 HEALTHCARE PROVIDERS NOW PART OF 
CAQH UNIVERSAL PROVIDER DATASOURCE

UPD Improves Administrative Efficiency and Serves as a Key Resource for Supporting Electronic Provider Directories

WASHINGTON, DC -

The CAQH® Universal Provider Datasource® (UPD®) has registered its 900,000th provider firmly establishing it as the go-to resource for complete and reliable self-reported data from physicians and other healthcare professionals. Three out of five licensed and practicing physicians in the country have signed up with the service. About 7,000 additional providers are registering each month. CAQH estimates that UPD reduces provider administrative costs by $105 million a year.

  • 5010 data transactions include patient eligibility/verification and claim status
  • Faster and more predictable administrative transactions enable doctors and hospitals to spend more time caring for patients

 

MINNETONKA, Minn. & WASHINGTON -

CAQH® and UnitedHealth Group (NYSE: UNH) today announced that UnitedHealth Group has completed the Committee on Operating Rules for Information Exchange® (CORE®) Phase I and II testing process. This process certifies that UnitedHealth Group can deliver more efficient and predictable patient-eligibility and claims-verification information to doctors, hospitals, physician offices and other care providers, according to operating rules developed by CORE.

Growth of CAQH Membership Reflects Importance of Administrative Simplification

Washington, DC and Philadelphia, PA -

As part of its ongoing efforts to simplify healthcare administration, CIGNA has joined CAQH® as a member company and will also participate on the CAQH Board of Directors, the organizations said today. CIGNA is among a growing list of industry organizations that contribute their expertise to the development and adoption of new ways to make healthcare administration more efficient. CAQH members now provide healthcare coverage for an estimated 156 million insured lives.