Health insurers use prior authorization as a check on the safety, quality, necessity and cost of medical services. When done manually, this process can be confusing, labor-intensive and expensive for the provider and payer teams that manage it. This can create delays to patient care, and frustrations across the industry.
CAQH at Large
National Lieutenant Governors’ Association Passes Resolution Calling for Administrative Simplification in Healthcare
CAQH has announced its support for a resolution passed by the
As national unemployment rates climb to historic levels, states and payers are experiencing weekly enrollment shifts in Medicaid, ACA marketplaces and employer sponsored insurance. To identify beneficiaries with overlapping health coverage, Medicaid programs need to establish coordination of benefit (COB) strategies that are scalable, accurate and cost effective.
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?
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.