In 2020, total spending on prior authorization increased to $767 million, with 86 percent of the spending incurred by providers. However, the CAQH Index estimates that $417 million could be saved annually if plans and providers moved to fully electronic transactions.
At the start of the pandemic, telehealth visits increased by over 7,500%. Join CAQH CORE and WEDI for a webinar on this rapidly expanding digital health landscape. Get an overview of WEDI and CAQH/CAQH CORE efforts related to telehealth. Our guest speakers will present and engage in a live discussion providing insights on key topics including:
Attend this informative webinar for an industry update on the status of electronic healthcare payments, including information from the CAQH Index, NACHA Volumes, and InstaMed’s “Trends in Healthcare Payments” report. In addition, learn how payment and remittance standards and operating rules can improve your billing and collection processes. We will have a conversation with our speakers on the latest trends and ways to benefit from standardization to improve revenue cycle management.
Join the CAQH CORE Team as we speak with CAQH CORE Board Member, Troy Smith, Vice President of Healthcare Strategy and Payment Transformation at Blue Cross Blue Shield of North Carolina. Troy will highlight BCBSNC’s priorities related to value-based payments and interoperability and discuss current industry challenges. He will also share his thoughts on how CAQH CORE and operating rules can continue to drive industry progress through alignment of clinical and administrative data.
Join us for our upcoming CAQH CORE Town Hall to learn about our current initiatives.
Platform offers easy access to work group information, resources and events.
In February 2021, CAQH CORE launched a new CAQH CORE Participant Dashboard. This user-friendly platform will simplify how participants can engage with their current work groups and join new ones. It also includes a global calendar of all CAQH CORE events, and enables easy access to all work group documentation, rosters and meeting information.
If you are a CAQH CORE participant and did not receive an email with information about how to register, please email core@caqh.org.
The X12 005010X221A1 Health Care Claim Payment/Advice (835) TR3 Implementation Guide is the HIPAA-adopted standard for claim payment/advice. This guide provides standardized data content for creation and use of the 835 transaction. The 835 is used throughout the healthcare marketplace by providers to post claim payments and adjustments to their accounting systems. CAQH CORE Payment & Remittance Operating Rules help the industry more effectively implement and use the 835 transaction to understand payment decisions and optimize denial management.
Join the CAQH CORE Team to learn more about new and updated CAQH CORE Operating Rules approved with overwhelming support in late 2020 for industry implementation, including:
The CORE Code Combinations organize claim denial and adjustment codes into unique business scenarios for more consistent code use across industry. CAQH CORE conducts a biennial Market-based Review (MBR) of the CORE Code Combinations to address industry business needs.
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.
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