Accurate, timely provider data is essential to keep the healthcare system running smoothly. Health plans and providers rely on it to develop directories, pay claims, refer patients to specialists and for the credentialing process. However, it is no secret that collecting and maintaining that data is difficult and has been a longstanding challenge in healthcare.
Collaboration across the industry is crucial for solving the challenges associated with inaccurate provider data. Following is an overview of CAQH efforts to convene the industry around this pressing issue.
An Industry Roadmap for Provider Data
In May 2018, the Provider Data Action Alliance, convened by CAQH and consisting of a diverse cross-section of industry leaders, released “An Industry Roadmap for Provider Data” that demonstrates a path to an accurate, efficient and sustainable provider data ecosystem.
The Roadmap details principles to guide the development of an industry-wide solution, an overall vision for what the provider data ecosystem should look like and a three-phase collaborative plan to implement the vision. Specifically, the Roadmap identified five major recommendations. You can read the full report here.
Here is a list of CAQH collaboration with industry leaders that shaped the Roadmap:
• White Paper: Defining the Provider Data Dilemma – CAQH developed a white paper in collaboration with Manatt Health, calling for industry collaboration and to level set the provider data discussion. The paper describes the challenges and environmental pressures on industry efforts to collect and maintain accurate provider data. It also informed discussions at the 2016 CAQH Provider Data Summit.
• 2016 Provider Data Summit: A Time to Act – More than 100 industry leaders from health plans, providers, vendors, government and consumer groups gathered in Washington, D.C., to discuss industry-wide issues related to provider data presented in the CAQH white paper. An Executive Summary was published after the Summit summarizing the challenges and recommendations developed by attendees.
• Provider Data Action Alliance – Attendees at the Summit recommended initiating a process to develop a shared industry vision and corresponding roadmap to address provider data challenges. In 2017, CAQH convened a group of cross-industry participants to begin work on the Roadmap.