CAQH, an industry alliance working to transform the business of healthcare, today announced that Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies, has joined other national health benefits companies in the effort to improve the accuracy of health care provider directories by participating in CAQH DirectAssure®.

Over 80 percent of industry stakeholders agree to time limits on requests for supporting information and final determinations on prior authorizations 


CAQH CORE, a multi-stakeholder organization representing a broad spectrum of health plans, providers, vendors, and government entities, has voted to set two-day time limits on how quickly health plans must request additional supporting information from providers and make final determinations on prior authorization requests.

Of the $350 billion widely cited as the cost of administrative complexity, $40.6 billion is spent on eight business transactions 


CAQH® today released the seventh annual report measuring the progress made by the healthcare industry in reducing the costs and burden associated with administrative transactions through automation. The 2019 CAQH Index found that, of the $350 billion dollars widely cited as the cost of administrative complexity in the US healthcare system, $40.6 billion is spent on eight administrative transactions.

Streamlining the way directory information is collected and shared with health plans can improve accuracy and save physician practices more than $1.1 billion


CAQH® today released results of a survey of providers across the US that revealed the administrative burden associated with maintaining provider directories. The survey of 1,240 physician practices, conducted in September 2019, determined that directory maintenance costs practices nationwide $2.76 billion annually.

Leading industry organizations align to accelerate electronic data exchange for prior authorization, medical documentation, and value-based payments


CAQH CORE and Health Level Seven International (HL7) today announced a collaboration to address long-standing healthcare industry challenges by accelerating automation and improving interoperability between administrative and clinical systems.  This is the first time these two organizations, which conduct complementary work to improve the electronic exchange of data across the healthcare industry, have collaborated on solutions to specific technical and administrative burdens.

Paper highlights six barriers to automation and a roadmap to a streamlined electronic process


CAQH CORE®, which represents a broad spectrum of health plans, providers, vendors, and government entities, today released a white paper entitled, “Moving Forward: Building Momentum for End-to-End Automation of the Prior Authorization Process” that identifies six barriers to adoption of electronic prior authorization, and initiatives that leverage standards and operating rules to accelerate automation.


Leading health plans across Texas are adopting CAQH ProView® to improve the accuracy of provider data. Participating plans in the state include Amerigroup, Superior HealthPlan and UnitedHealthcare, whose combined membership represents nearly 4 million Texans and more than 50% of the Medicaid covered population.

Guidelines established by industry will reduce inefficient information exchange between plans and providers, reduce costs, and help remove barriers to care


CAQH CORE today released Phase V Operating Rules approved by the CAQH CORE Board to strengthen the accuracy and consistency of the prior authorization process and move the industry toward full automation.

84 percent of “attachments” sharing medical information between providers and health plans are exchanged through mail or fax, resulting in administrative inefficiency and delays in patient care


CAQH CORE today released a white paper, “CAQH CORE Report on Attachments: A Bridge to a Fully Automated Future to Share Medical Documentation” on the challenges associated with the exchange of medical information and supplemental documentation used for healthcare administrative transactions. The report identifies five areas to improve processes and accelerate the adoption of electronic attachments.


CAQH CORE has awarded more than 350 certifications to healthcare organizations that conform to CAQH CORE Operating Rules. In becoming certified, these entities – which include health plans, Medicaid programs, providers, vendors and more – demonstrate their commitment to automation, interoperability and efficient business processes.