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.
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For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly.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.
CAQH CORE is hosting a series of interactive webinars to give healthcare leaders an opportunity to engage and collaborate during this time of social distancing.
The Benefit Enrollment Operating Rules create consistent processes and infrastructure requirements for employers, unions, government agencies, and other organizations to enroll members in a healthcare benefit plan.
For years, inaccurate provider directory data has been a concern for the healthcare industry - causing frustration for health plans and providers, and potentially creating barriers to care. As CAQH highlighted in the white paper The Hidden Causes of Inaccurate Provider Directories, one of the causes of directory errors is the administrative burden practices face when responding to a high volume of health plan requests for information and updates.
Provider data drives the most fundamental processes in the healthcare system. The industry uses provider data to connect patients with healthcare providers, license practitioners, exchange information and pay for services. Though the industry spends more than $2 billion annually to maintain provider data, inaccuracies and inefficiencies persist.
A variety of factors contribute to poor quality provider data, such as the proliferation of proprietary platforms and technologies.