Establishing the Building Blocks for Price Transparency: Industry Guidance on Provider to Payer Approaches for Good Faith Estimate Exchanges
This guidance document is the first of a series of recommendations developed by the CAQH CORE Advanced Explanation of Benefits (EOB) Advisory Group. The Advisory Group launched in August 2021 as a forum for stakeholders across the healthcare industry to collaborate and build consensus around recommendations for how to implement components of the No Surprises Act, signed into law in December 2020. The Advisory Group included over 60 participants representing over 30 diverse healthcare organizations including providers, health plans, vendors, clearinghouses, associations, government entities, and standards development organizations. The initial scope of the Advisory Group, and the focus of this guidance document, are recommendations pertaining to messaging standards, connectivity protocols, and related data content to support the exchange of Good Faith Estimates between providers and payers. These recommendations are for use by healthcare industry stakeholders and policy regulators.
Keeping it Together: Lack of Uniformity for Exchanging Medical Documentation Costs the Industry Time, Money and Frustration
This CAQH CORE issue brief published in November 2020, highlights findings from a CAQH CORE industry survey on exchanging medical documentation conducted at the end of 2019 with more than 340 respondents. The purpose of the survey was to better understand how health plans and providers are currently exchanging attachments for four use cases: prior authorization, healthcare claims, quality measurement, and value-based payment to inform the development of operating rules to support a more standardized workflow.
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.
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.
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.
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.