Health plans

Beginning in July 2000, the founding CAQH members launched a series of initiatives to improve the quality of healthcare and reduce administrative burdens for physicians, patients and payers. These first programs were designed by work groups of health plan and CAQH staff, developing tools and technologies to support physicians and educate patients about vital health issues and insurance benefits.

While today CAQH is focused on streamlining business challenges, some of the early initiatives addressed clinical issues. Here are a few examples:

Health Outcomes.

What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?

Each year, CAQH publishes a report that tracks the progress the healthcare industry is making toward automating business transactions. For example, the 2019 CAQH Index found that the medical and dental industry could save an additional $13.3 billion dollars annually by automating administrative transactions.

This research is made possible through the voluntary participation of stakeholders from across healthcare.

For the fifth consecutive year, CAQH, an industry alliance working to streamline the business of healthcare, has been named one of the “Best Places to Work” by Modern Healthcare.

CAQH CORE will be playing an active role in this year’s WEDI Forum, and leading two sessions during the three-day event:

SSI Group and Availity, two leading revenue cycle management companies, are the latest organizations to achieve new CAQH CORE Certifications. Both are now CAQH CORE-certified for Prior Authorization & Referrals (infrastructure). Availity also achieved certification for Health Care Claims. Previously, both SSI and Availity were CAQH CORE-certified for Eligibility & Benefits, Claim Status and Payment & Remittance.

Managing coordination of benefits (COB) is challenging for many health plans, but Medicaid plans face among the greatest obstacles. For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly. These plans also have limited resources for identifying third-party liability, although they are required by law to do so.

And now, as team members involved in COB work remotely, these hurdles can become even greater.

Now that states have started the process of reopening and our healthcare system is beginning to return to normal operations, this is an ideal time for providers to make sure their professional and practice information in CAQH ProView is up to date.

As remote work continues amid the COVID-19 pandemic, CAQH CORE has hosted a series of interactive webinars to bring stakeholders together to discuss some of the industry’s most pressing topics. These virtual sessions have given healthcare leaders a rare opportunity to engage and collaborate during this time of social distancing.