Health plans

Your provider directory may advertise claims payment addresses for practice locations

Collecting and confirming provider data is a time-consuming and costly venture.

Providers are inundated with requests from payers for updated practice information while attempting to balance treating patients and juggling other administrative concerns. For some providers it all comes down to ensuring they are reimbursed in a timely fashion, this is why they will often default to using their claims reimbursement address in every ask for contact or practice information.

DirectAssure 2.0 Feature Comparison

Recent releases have included features that enable participating organizations to:

  • Meet directory requirements in the Federal "No Surprises Act"
  • Comply with state requirements related to race, ethnicity and language and other    updates
  • Enhance cultural competency and provide directory information of interest to diverse and underserved communities
  • More efficiently and accurately manage data

If your organization is using DirectAssure 1.0, you are receiving basic features to meet regulatory requirements:

Maintaining High Quality Credentialing Amid The Great Resignation

As a result of COVID-19, and the strain the pandemic has put on healthcare providers, unprecedented numbers of clinicians are leaving their practices–or healthcare altogether.

For health plans, this high level of turnover could have significant consequences for the size and quality of their provider network–as well as their ability to maintain an accurate provider directory.

Improving Health Plan Provider Directories

More than half of patients use health plan provider directories to find an in-network clinician that is right for them. Despite industry efforts, however, directory inaccuracies have been a persistent challenge. When directory information is incorrect, patients can be inconvenienced and face financial consequences. To address these issues, policymakers at the federal and state levels are requiring health plans and practices to put processes in place to improve provider directory data.

Current Initiatives for CAQH CORE Participants

CAQH CORE Participating Organizations help ensure that operating rules continue to meet evolving business needs, by engaging in the rule development process and maintenance of existing operating rules. Work groups are open to all CAQH CORE Participating Organizations, and multiple individuals from the same Participating Organization may join. Because each organization has only one vote, participants collaborate with their colleagues to submit an organizational-level response during voting periods. 

Prior Authorization Automation Case Study Webinar with Cleveland Clinic, PriorAuthNow and CAQH CORE

CAQH CORE, together with Cleveland Clinic and PriorAuthNow (PAN), is pleased to share initial findings highlighting the impact of greater prior authorization (PA) automation and workflow integration leveraging standards and operating rules at Cleveland Clinic. The Cleveland Clinic will share how the implementation of an integrated PA solution is improving the ability of staff to conduct PAs and creating a more efficient process.

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