Reports and White Papers

The Connectivity Conundrum: How a Fragmented System is Impeding Interoperability and How Operating Rules can Improve it

Over the years, healthcare industry stakeholders have implemented a multitude of methods connecting applications, systems and networks to exchange administrative and clinical healthcare data. This has resulted in a fragmented ecosystem that is impeding interoperability and administrative simplification. The Connectivity Conundrum white paper, published in December 2019, is an in-depth study of the challenges and opportunities associated with connectivity.

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Executive Summary

Moving Forward: Building Momentum for End-to-End Automation of the Prior Authorization Process

Moving Forward: Building Momentum for End-to-End Automation of the Prior Authorization Process, a CAQH CORE white paper published in July 2019, identifies six barriers to adoption of electronic prior authorization, and initiatives that leverage standards and operating rules to accelerate automation. Prior authorization has been used for decades and yet significant operational challenges still exist. This white paper outlines how we got to where we are today and offers a roadmap for collaborative solutions.

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Executive Summary

Press Release

 

CAQH CORE® Report on Attachments: A Bridge to a Fully Automated Future to Share Medical Documentation

The CAQH CORE Report on Attachments: A Bridge to a Fully Automated Future to Share Medical Documentation, published in May 2019, examines 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.

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Executive Summary

Press Release

 

All Together Now: Applying the Lessons of Fee-for-Service to Streamline Adoption of Value-Based Payments

All Together Now: Applying the Lessons of Fee-for-Service to Streamline Adoption of Value-Based Payments, a CAQH CORE report published in March 2018, analyzes operational challenges that may slow or add costs to the implementation of value-based payment. The research found that industry collaboration is needed to minimize variations and identified five operational opportunity areas that, if improved, would smooth implementation.

Full Report

Executive Summary

Press Release

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