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.
CAQH CORE has produced a variety of online resources to provide education on operating rule implementation and CAQH CORE initiatives.
CAQH CORE has developed interactive tools and dashboards on topics of interest to industry stakeholders.
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.
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:
What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?
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.