Texas Health Plans Use CAQH ProView to Improve Provider Data Accuracy

Texas Health Plans Use CAQH ProView to Improve Provider Data Accuracy

May 22, 2019

Leading health plans across Texas are adopting CAQH ProView® to improve the accuracy of provider data. Participating plans in the state include Amerigroup, Superior HealthPlan and UnitedHealthcare, whose combined membership represents nearly 4 million Texans and more than 50% of the Medicaid covered population.

“This announcement is about improving access to healthcare for millions of Texans,” said Robin Thomashauer, CAQH President. “When practice locations and other information in directories is inaccurate, members have a harder time finding the care they need. Using CAQH ProView, these health plans will give members more timely and accurate information about doctors, while reducing the administrative burden on the plans and providers.”

Improving the accuracy of provider data is a challenge for our nation’s healthcare system, and it is one that plans and providers must work together to address. According to a recent audit of Medicare Advantage online provider directories by the Centers for Medicare and Medicaid Services (CMS), nearly half of all data in online provider directories may be inaccurate. 

Texas is just the latest state where health plans are working together and with CAQH to solve this problem.  Plans in Massachusetts and Tennessee recently announced that they also have selected CAQH ProView, and plans in other states are expected to make similar announcements in the near future. 

More than 1.4 million healthcare providers nationwide, including more than 100,000 in Texas, log into the CAQH ProView web-based portal to share their professional and practice information with participating health plans. By using a solution that most providers and practice managers are already familiar with, these plans will deliver better information to their members sooner, without adding burdens to healthcare providers.

CAQH also recently added new features for CAQH ProView that will make it even easier for delegated provider groups to submit demographic updates for their providers. As part of this announcement, the Texas plans and CAQH are committed to identifying additional ways to streamline and improve provider data management.

“Inaccurate provider data impacts everyone involved – health plans, providers and members,” said Andi Gillentine, Chief Operations Officer at Superior HealthPlan. “By aligning behind a common channel for data updates -- and one that most providers already use -- we are taking a positive step forward in addressing a complex problem that our industry has faced for quite some time.”

About CAQH

For more than 20 years, CAQH has helped nearly 1,000 health plans, 1.6 million providers, government entities and vendors connect, exchange information and operate more efficiently. CAQH technology-enabled solutions and its Committee on Operating Rules for Information Exchange (CORE) bring the healthcare industry together to make sharing business information more automated, predictable and consistent. CAQH Explorations researches opportunities to reduce the burden of manual processes in healthcare administration. Visit www.caqh.org and follow us on Twitter: @caqh.