CAQH Press Releases | Affordable Quality Health Care Press | News

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.

Technology delivers better data, more efficiently, with less provider abrasion


CAQH® has developed patent-pending artificial intelligence (AI) technology to identify incorrect healthcare provider data and improve the accuracy of directories without contacting the provider. Health plans can use the findings to improve data quality and decide which office locations and other information about a provider to publish in their directories.

MD-Staff now generates CAQH ProView for Groups-compatible rosters that can be submitted to multiple plans at once


Applied Statistics & Management Inc. (ASM) and CAQH® today announced that they are working together to make it easier for large provider groups to share credentials and other information with health plans. MD-Staff, the ASM flagship credentialing system, now automatically generates rosters that may be uploaded directly into CAQH ProView for Groups, enabling provider organizations to submit information about their providers accurately and efficiently with multiple health plans at once.


Leading managed care plans in Tennessee have adopted CAQH ProView  to increase the accuracy of provider data in the state. Participating plans include Amerigroup Tennessee, BlueCross BlueShield of Tennessee, and UnitedHealthcare.

Opportunity for $12.4 billion in additional savings exists through further automation


CAQH released the 2018 Index today, which reveals that the healthcare industry continues to make progress automating business processes. Electronic adoption and transaction volume increased, with several common transactions reaching 80 percent electronic adoption across the sector. This progress resulted in a narrowing of the cost savings opportunity for the first time in CAQH Index history.