CAQH CORE will provide an update of its 2020 Goals and priority initiatives to deliver administrative efficiency and value to the healthcare industry. Topics will include:
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.
Connectivity is essential for successful interoperability as it enables the transport of information to support data exchange. To address the industry’s need to align on a common set of communication protocols, CAQH CORE maintains a set of operating rules addressing connectivity and security of data exchange. CAQH CORE Participating Organizations are currently evaluating updates to the CAQH CORE Connectivity requirements to address existing and emerging standards and protocols to support the intersection of administrative and clinical data exchange.
On June 23, CAQH CORE staff will host a panel discussion featuring CAQH CORE Board members centered on key industry topics, including value-based payments, interoperability, and COVID-19.
Dr. Sue Turney (MGMA) President and CEO, Marshfield Clinic Health System
Tim Kaja Chief Operating Officer of UnitedHealth Networks, UnitedHealthcare
Dr. Marilyn Heine (AMA) Clinical Assistant Professor of Medicine, Drexel University College of Medicine
The Premium Payment (820) transaction provides the format for transmitting information relating to payments. The CAQH CORE Premium Payment Operating Rules support consistent infrastructure and a connectivity safe harbor across the industry.
Join the CAQH CORE team for an update of current and ongoing initiatives to deliver administrative efficiency and value to the healthcare industry. Topics will include:
The ASC X12N Health Care Services Review – Request for Review and Response (278) is a paired transaction set. This transaction set is also known informally by other names, such as Referral or Prior Authorization. The 278 is used throughout the healthcare marketplace by providers to electronically submit prior authorization and referral requests.
Coming in Spring 2020
CAQH CORE has restructured its operating rules from phase-based rule sets to rule sets based on business transactions.
Register for this webinar to understand how pursuing CORE Certification can ensure your alignment with the CAQH CORE Operating Rules, many of which are federally mandated. Highlights will include: