CAQH Press Releases | Affordable Quality Health Care Press | News

New Certification Progress Report Highlights Healthcare Industry Progress and Gaps in Move Towards Streamlined, Electronic Sharing of Administrative Data 


CAQH CORE, a multi-stakeholder collaboration of more than 130 public and private entities across the healthcare industry, announced today that it has awarded over 300 certifications to health plans, hospitals and health systems, clearinghouses and vendors. Aetna and Cigna, two of the nation’s largest insurers, recently became certified in the Phase III CAQH CORE Operating Rules, continuing the industry momentum toward more streamlined, electronic administrative data sharing. 

Providers Could Gain 1.1 Million Labor Hours Per Week with Full Adoption of Electronic Transactions

WASHINGTON, DC - 1/12/17

Widespread adoption of electronic business transactions in healthcare continues to grow but a significant opportunity for $9.4 billion in annual savings remains, according to new data released today in the 2016 CAQH Index®. Conducting resource-intensive manual transactions costs U.S. health plans and healthcare providers as much as $11 more per transaction and on average $6 more than when conducted electronically. Millions of these transactions are exchanged daily.

The fourth annual CAQH Index measures adoption, costs and, for the first time, provider labor time associated with the most common administrative transactions conducted between health plans and providers. These include verifying a patient’s insurance coverage, sending and receiving payment, inquiring about the status of a claim and obtaining prior authorization for care.

WASHINGTON, DC - 10/27/16

CAQH, a nonprofit alliance creating shared initiatives to streamline the business of healthcare, has been selected by Modern Healthcare as one of the 2016 Best Places to Work in Healthcare.

“CAQH is committed to fostering a workplace of excellence where employees are encouraged to offer innovative ideas, make valuable contributions as individuals and support each other’s efforts,” said CAQH Executive Director Robin J. Thomashauer. “This recognition also underlines our commitment to a strong set of values and practices that enable us to attract and retain a stellar workforce.” 

Accurate Provider Data Critical to Improving Quality, Costs of Healthcare Delivery

WASHINGTON, DC - 9/28/16

Full industry collaboration is required to develop an effective approach to collecting, maintaining and disseminating accurate, high-quality data from healthcare providers, according to a new white paper from the non-profit alliance CAQH. “Defining the Provider Data Dilemma: Challenges, Opportunities and Call for Industry Collaboration,” will inform the discussion when healthcare industry leaders gather in Washington on Sept. 29 at the 2016 Provider Data Summit, hosted by CAQH, to explore the topic.

Business partners help health plans meet ACA requirements and promote secure and efficient exchange of administrative data


Health plan trading partners are increasingly seeking CORE Certification as a way to help their clients improve administrative processes and meet Affordable Care Act (ACA) requirements, according to the CAQH Committee on Operating Rules for Information Exchange (CORE).  CAQH CORE has awarded nearly 300 Certifications to date, nearly half of which are to entities that facilitate efficient electronic transactions for health plans.   

New Industry Progress Report Finds Increasing Adoption of Fully Electronic Claims-Related Processes, But Opportunity for Significant Improvement Remains

WASHINGTON, DC - 3/30/16

The U.S. healthcare system is unnecessarily spending billions of dollars each year by continuing to use manual administrative processes for basic transactions, according to the 2015 CAQH Index® released today. Despite steady increases in the industry adoption of HIPAA electronic administrative transactions, the report emphasizes a remaining opportunity to save more than $8 billion each year.

Leader in Provider Data Enables 1.3 Million Providers to Use Self-Reported Information in CAQH ProView to Meet New Regulations

WASHINGTON, DC - 2/17/16

The non-profit alliance CAQH today announced a new, fully-electronic solution to improve the quality of provider data in health plan directories. Launching as regulatory requirements increase for accurate provider directory information, DirectAssure is designed to help relieve the associated burden on healthcare providers.

CORE Certification becomes the gold standard for electronic healthcare data exchange

WASHINGTON, DC - 11/4/15

The CAQH Committee on Operating Rules for Information Exchange (CORE®) today announced that it has awarded more than 200 CORE Certifications to health plans, hospitals and health systems, clearinghouses and vendors.  Widely regarded as a must-have seal of approval across the healthcare industry, CORE Certification signifies that these organizations follow a set of HIPAA-mandated standards and operating rules for exchanging electronic administrative data.

CAQH CORE Announces Phase IV Package for Claims, Prior Authorization, Employee Premium Payment, Enrollment and Disenrollment

WASHINGTON, DC - 9/23/15

The CAQH® Committee on Operating Rules for Information Exchange (CORE®) today announced the approval of the Phase IV CAQH CORE Operating Rules package for four healthcare business transactions: healthcare claims; prior authorization; employee premium payment; and enrollment and disenrollment in a health plan.

2014 CAQH Index Shows Progress, Gaps in Switch from Manual to Electronic

WASHINGTON, DC - 3/17/15

U.S. healthcare could save $8 billion annually by transitioning six routine business transactions from manual to electronic, according to the newly published 2014 CAQH Index™. The CAQH Index tracks progress from manual (e.g., via phone, fax or mail) to industry standardized (HIPAA) electronic administrative transactions between health plans and healthcare providers. This annual report, the second from CAQH, details adoption rates and potential savings.