CAQH at Large

Earlier this year, April Todd spoke to AJMC's Managed Care Cast about the impact of two-day rules on streamlining prior authorization. This became the podcast's most popular episode of 2020. 

Click here to listen to the podcast. 

This month, April Todd presented the new CAQH Endpoint Directory solution at the Office of the National Coordinator for Health Information Technology’s (ONC), Accelerating APIs in Healthcare: A Year in Review and Momentum for 2021 virtual event.

Last month, CAQH CORE passed new Operating Rules for patient attribution data exchange and an update to existing connectivity rules:

CAQH CORE Value-based Payments Attribution Rules Package

For the past decade, the CAQH Index has tracked the adoption of electronic administrative transactions between medical and dental providers and payers. In that time, it has become an authoritative source of information on our nation’s progress toward a more automated and efficient healthcare system.

For more than a decade the healthcare industry has been guided by the triple aim: the goal to deliver an improved patient experience, at lower costs, while improving the overall health of a population. But as providers are expected to deliver more value and take on more financial risk, a fourth aim has been added — avoiding physician burnout.

The credentialing process can be cumbersome for both healthcare providers and health plans. Over the years, solutions have been developed to alleviate the burdens associated with this workflow. But, while advances have been made in automating credentialing, a new problem has emerged: plans and providers are using a multiplicity of platforms that do not communicate with one another.

This month, April Todd, Senior Vice President CORE and Explorations, was invited to speak about prior authorizations on the Change Healthcare.