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Fierce Healthcare: Payer innovation council weighs improvements to provider data management experience

Preview of Fierce Healthcare's article

CAQH innovation council brought together some of the nation’s largest health plans to raise issues and look for ways to improve complex processes, including credentialing and provider data management.

It’s one of the first times payers have sat down together to solve these pain points, CAQH CEO Sarah Ahmad told Fierce Healthcare in an interview. The health plan representatives met in-person just one day before AHIP 2024 kicked off in Las Vegas last week.

“You don’t see that in healthcare these days,” said Ahmad, whose company assembled the leaders.

CAQH is a provider data management company that works on the provider side to credential and handle directory management, and on the member side to handle coordination of benefits.

“One of the biggest issues that payers, as well as providers and members, [have] is the data quality they’re seeing in a directory,” she explained. “If you don’t have that information correct … a lot of things can break down.”

Directory information includes provider addresses, tax ID numbers, office hours, specialties, if they’re accepting new patients and more. Should that information be outdated or incorrect, patients will struggle to attend appointments and access providers.

In credentialing, Ahmad says many of the same problems that existed 20 years ago are still issues today. The credentialing process, required of providers looking to obtain verification and be part of a payer’s network, can be long and arduous.

To simplify the process, CAQH raised the idea of creating a universal roster, where a provider would fill out necessary paperwork once, instead of duplicating efforts with every payer a provider contracts with just to be part of an individual network. That universal roster would be shared among payers and drastically reduce administrative burden.

“I think the biggest problem has been getting all the payers aligned,” she said. “I think when it comes to provider data we still have some ground to take because the complexity of getting everyone to agree.”

She also said that she knows the federal government is looking into improving directory management frustrations, and urged officials to listen to health plans in order to come up with the best solutions.