CAQH Press Releases | Affordable Quality Health Care Press | News

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.

UNIVERSAL PROVIDER DATASOURCE ESTABLISHES BENCHMARK FOR PROVIDER SELF-REPORTED DATA QUALITY

Continuous Improvement Will Increase Accuracy of Healthcare Utility to 97% or More

WASHINGTON, DC -

CAQH® released the results of a landmark study to assess the quality and accuracy of data reported by providers about their professional credentials and practice information at its 2010 Administrative Simplification Conference. The study was conducted based on a thorough review of 108 data points that providers self-report to the Universal Provider Datasource® (UPD®), which electronically gathers provider data from all 50 states and the District of Columbia for credentialing and other uses, such as member directories.

CAQH BOARD OF DIRECTORS ELECTS DAVID WICHMANN
OF UNITEDHEALTH GROUP AS NEW CHAIRMAN

WASHINGTON, DC -

CAQH® announced today that its board of directors has elected David S. Wichmann, executive vice president, UnitedHealth Group and president, UnitedHealth Group Operations, to serve as the new board chair.

HEALTH CARE SERVICE CORPORATION SELECTS UPD AS PROVIDER DATA SOLUTION

Nationally Recognized Utility Chosen to Streamline Credentialing for Physicians and Allied Healthcare Professionals in Four States

WASHINGTON, DC -

CAQH® announced today that Health Care Service Corporation (HCSC) has selected the Universal Provider Datasource® (UPD®) to streamline provider data collection. HCSC will use the UPD service to electronically gather provider data for credentialing and other uses, such as member directories.

HCSC is a Chicago-based health benefits company serving 12.4 million members. It is the fourth largest health insurer and the biggest customer-owned health insurer in the United States.

BLUECROSS BLUESHIELD OF TENNESSEE ACHIEVES CAQH CORE PHASE II CERTIFICATION

Increased Adoption of Administrative Data Exchange and Interoperability Rules Enhance Service for 3 Million Members

WASHINGTON, DC -

CAQH® announced today that BlueCross BlueShield of Tennessee (BCBST) has achieved certification for its implementation of the CAQH Committee on Operating Rules for Information Exchange® (CORE®) Phase II rules. The certification will benefit more than 3 million insured members of the Tennessee health plan.

CIGNA ACHIEVES CORE PHASE I CERTIFICATION

Nearly 600,000 Providers Nationwide Can Access Streamlined Eligibility and Benefits Data From One of the Nation’s Largest Plans

WASHINGTON, DC -

 CAQH® announced today that CIGNA has earned certification for electronically exchanging administrative data, for more than 11 million medical customers, using the CAQH Committee on Operating Rules for Information Exchange® (CORE®) Phase I operating rules. The CORE rules are improving the flow and data content of administrative exchanges between providers and health plans.