Fall 2008
SPECIAL EDITION: CAQH CONFERENCE RECAP

2008 CAQH Administrative Simplification Conference Summary

More than 150 healthcare professionals representing health plans, associations, vendors, providers, and the government gathered September 24 – 25, 2008 in Washington, DC to attend the inaugural CAQH Administrative Simplification Conference. Attendees learned how CAQH, its initiatives, and its members are improving healthcare administration. Presentation topics ranged from using Universal Provider Datasource (UPD) data for emergency responder registries to capturing delegate and large practice data to the national drive toward interoperability and achieving an all-payer solution with the Committee on Operating Rules for Information Exchange (CORE) rules.

The event built on the successes of past CAQH Universal Credentialing Datasource Best Practices Conferences and featured concurrent tracks on UPD and CORE topics. Attendees were able to attend sessions offered in either track, with many attendees participating in both. See below for a synopsis of each presentation by track or click http://www.caqh.org/adminconference2008.php to access a complete list of conference presentations.

Following videotaped opening remarks from CAQH Board Chair and Aetna, Inc. Chairman and CEO Ronald Williams, Kevin Hutchinson, President and CEO of Prematics, Inc., delivered the conference keynote. Prematics is a provider of managed IT services that improve the safety, quality and efficiency of healthcare. Hutchinson also is a Board member of the AHIC Successor, Inc. His presentation, Collaborating to Transform Healthcare, touched on interoperability, standards creation, AHIC, the Nationwide Health Information Network (NHIN), CAQH and the tools the industry needs for intra- and inter-industry collaboration.

Following lunch, Rick Ramsay, AHIP vice president of State Advocacy, provided an update on state IT legislative efforts. His presentation, A Review of 2008 State Legislative Activity on Transparency: Health IT & Administration Simplification, highlighted the increasing state-level activity focused on administrative simplification. Ramsay discussed how both of the CAQH initiatives are addressing state interests today. He also provided a forecast of states to watch in 2009.

Upcoming CORE Conferences

There are several upcoming opportunities to learn more about CORE. Please click on each event for more information.

TEPR 2009;
Feb. 2 - 5, 2009

AAPPO 2009 Annual Forum;
Feb. 8 - 10, 2009

Visit CAQH often to learn of
upcoming events.

New CORE Certification

Clearinghouses/Products
RealMed LP–
RealMed Revenue Cycle Management



New CORE Endorser

American Medical Association (AMA)


New CORE Participants

Gateway EDI
mPay Gateway



New CORE Statements of Support

American Association of Preferred Provider Organizations (AAPPO)

America's Health Insurance Plans (AHIP)

American Medical Association (AMA)


Pending CORE Certifications

Health Plan
Humana Inc.

Vendors/Clearinghouses
Healthvision
InstaMed

CAQH launched the Committee on Operating Rules for Information Exchange (CORE) to develop an all-payer solution that ensures electronic healthcare administrative data exchange is streamlined and consistent, regardless of the technology. CORE is more than 100 industry stakeholders collaborating on a set of uniform business rules that are built on existing industry requirements. CORE participating organizations collectively cover more than 130 million lives or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries.

The National Drive Toward Interoperability

How the CAQH CORE Rules Make a Difference

This presentation covered the purpose of and relationship among the Healthcare Information Technology Standards Panel (HITSP), American Health Information Community (AHIC), Certification Commission for Healthcare Information Technology (CCHIT), and Nationwide Health Information Network (NHIN). Creating standards, building a framework for health IT (HIT) solutions and the standards harmonization process, along with the role CORE is playing in national HIT efforts, also were discussed.

Speaker: LeRoy Jones, Program Manager of HITSP (on behalf of ANSI), Principal and Chief Executive of GSI Health


How a “Recognized Certification Body” Uses Harmonized Health IT Standards

CCHIT explained the strategic role of certification in the national HIT framework, the CCHIT certification criteria development process and how inspection and certification are conducted. The speaker also discussed the relationship between the CORE rules and CCHIT certification.

Speaker: Alisa Ray, Executive Director, CCHIT

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Measuring CORE ROI

An IBM Study Update

IBM is currently conducting a study to evaluate the return on investment (ROI) of exchanging healthcare administrative data according to the CORE rules. The study is looking at cost savings, the impact on communication volumes, satisfaction levels and time savings. Initial study results suggest that there will be several ROIs to report.

Speaker: Margaret Neuer, Senior Managing Consultant of Healthcare Strategy and Change, IBM

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Achieving an All-Payer Solution: Regional and National Implementations of the New CORE Phase II Rules

BCBSA

The Blue Cross Blue Shield Association discussed the commonalities, cooperation and next steps between BlueExchange, an inter-Blues health plans interoperability program to manage national accounts, and CORE.

Speaker: Rich Cullen, Managing Director of Inter-Plan Program, BCBSA


BCBSNC

Blue Cross Blue Shield of North Carolina addressed the impact of CORE Phase II rules adoption, including what will be required to manage anticipated gaps between current systems and rules requirements, and the effect of the CORE-BlueExchange collaboration.

Speaker: Morgan Tackett, Director of Electronic Solutions, BCBSNC


RealMed

RealMed offered a vendor perspective on CORE by detailing its decision to become a CORE participating organization in 2007, the benefits it is experiencing from that participation and its thought process behind becoming CORE-certified.

Speaker: Kathy Underwood, Director of Technical and Business Services, RealMed Corporation

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CORE Connectivity Rules

Leading the Way in Healthcare Administrative Communications

Presenters shared information about the connectivity challenges and key principles addressed by the CORE Phase I and II rules, and connectivity priorities under consideration for CORE Phase III.

Speakers: Mitch Icenhower, Director of HDX, Siemens; Jay Eisenstock, Manager of Provider eSolutions, Aetna; Deb Smithline, Product Manager, NaviMedix

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CAQH CORE Phase II Certification

Testing Status Report

This presentation provided an overview and a demonstration of the Edifecs CORE Phase II testing product.

Speaker: Herb Larsen, SVP of Alliances, Edifecs

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The Future of CORE

Phase III Town Hall Discussion

This presentation took the format of a town hall meeting to gain input on the future of CORE Phase III and beyond. Topics include the CORE strategic plan and immediate goals, the expected timeline of federal mandates, and focus areas for potential CORE Phase III rules.

Speakers: Harry Reynolds, Vice President, BCBSNC and CORE Chair, CAQH; Gwendolyn Lohse, Managing Director, CORE, CAQH

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UPD STATS AT A GLANCE

The number of physicians and other healthcare providers using the Universal Provider Datasource continues to grow. On average, 8,000 - 10,000 providers join the data-collection service each month.

Totals as of November 20, 2008:

UPD Registered Providers
638,890

Completed UPD Applications
586,251

Paper Applications Eliminated
2.05 million

Annual Administrative Savings
$77 million (2.7 million hours)


NEW UPD PARTICIPANTS
August 2008 - October 2008

Peoples Health
American Health Network of Indiana
HealthSpring, Inc.
Fidelis Care New York
St. John's Healthcare
Unity Healthcare
Kaiser Foundation Health Plan of
  Georgia
Space Center IPA
Texas Professional Healthcare
   Alliance
Select Health of South Carolina
American Chiropractic Network
Principal Financial Group
Beacon Health Strategies
AGMCA/Akron General PHO
Stark Regional PHO
The Physicians Assurance
  Company (TPAC)
Ohio State University Health System
Mercy Health System PHO of Ohio
Valley Health Network
Childrens Hospital Medical Center
   (Cincinnati)

Launched in 2002 by CAQH, the Universal Provider Datasource (UPD) is achieving its vision of simplified provider data collection by reducing paperwork and millions of dollars of annual administrative costs for more than 635,000 providers and over 450 health plans, hospitals and MCOs across the United States.

Universal Provider Datasource

Positioned for the Future

Presenters updated attendees on the transition of the UPD service to ACS, gave an overview of the ACS role in UPD going forward, and discussed CAQH/ACS strategies for enhancing UPD in the future.

Speakers: Beth Kranda, Sr. Sales Executive, ACS; Jackie Gentner, Strategic Business Unit Manager, ACS; Rob Marrow, Vice President, Healthcare Administration, ACS

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Defining Quality

An Update from the Universal Provider Datasource Data Quality Task Force

This presentation examined the objectives, responsibilities, progress, and next steps of the CAQH task force in evaluating the quality of UPD data.

Speakers: Carrie Call, National Director of Provider Data Quality, UnitedHealthcare; Rishma Mohamed, Consultant

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New Directions for the Universal Provider Datasource

Role of Emergency Responder Registries

The Massachusetts System for Advance Registration of Volunteer Health Professionals (MSAR) is considering using the CAQH UPD to communicate with potential medical volunteers. In this presentation, MSAR outlined the various challenges that arise in successfully integrating volunteers in an emergency setting and offered insights on how state emergency responder registries can benefit from the UPD.

Speaker: Mary E. Clark, JD, MPH, Director of the Emergency Preparedness Bureau, Massachusetts Department of Public Health


Army National Guard

This presentation examined how Tenon Consulting and Anthem Credentialing Services partnered on a solution built around UPD data to centralize Army National Guard clinical credentialing activities. Speakers discussed the approach, philosophy on adaptability and lessons learned.

Speakers: Anthony Begando, CEO, Tenon Consulting Solutions; Christina McGovern, Anthem Credentialing Services Inc. (ACSI) at WellPoint

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Unlocking the Value: Using UPD Data Throughout the Enterprise

Industry Leading Automation with CAQH Datasource

Blue Cross Blue Shield of Vermont (BCBSVT) explained how their work with Vistar Technologies and CAQH is helping them to eliminate data entry by automating processes. Vistar described how its systems create a single enterprise repository, while maintaining data integrity and short cycle times.

Speakers: Kathy Cota, Network Quality Coordinator, BCBSVT; Myra Ameigh, President and CEO, Vistar Technologies


Value of Credentialing Data

Portico Systems is finding value in using CAQH provider data for applications such as contract renewals and provider directories. The speaker addressed considerations in using this data, including security and trust in data quality. The presentation also provided insight into how the different users and components of Portico Systems and the UPD system interact.

Speaker: Nanci Ziegler, Executive Vice President of Market Strategy and Business Development, Portico Systems

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The Last Frontier: Capturing Delegate and Large Practice Data

University of Kentucky HealthCare Credentialing & CAQH

This presentation discussed how University of Kentucky HealthCare works with its health plans, adapts its process to include UPD information and implements regulatory requirements.

Speaker: Paula Bargo, Medical Staff Coordinator, University of Kentucky HealthCare/Kentucky Medical Services Foundation, Inc.


Delegation and CAQH

WellPoint reviewed its current approach to delegation and described the related challenges. The presentation also explored how CAQH can assist with the delegation process.

Speaker: Amy Niehaus, CPMSM, CPCS, MBA, Director of Credentialing Technologies, WellPoint

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E-Prescribing Forum

On September 24, 2008, CAQH co-hosted a Payer e-Prescribing Forum with AHIP and the Center for Improving Medication Management. The one-day interactive forum brought together approximately 50 health plan medical directors, pharmacy directors, provider relations staff, CIOs and other payer organization professionals to discuss new strategies for accelerating the adoption of e-Prescribing.

U.S. Senator Sheldon Whitehouse (D-RI), founder of the Rhode Island Quality Institute, a collaborative effort between health care providers, insurers and government that has pioneered efforts to expand the use of electronic prescriptions, kicked off the event by delivering the keynote address. In the Senate, Whitehouse has made health care reform the subject of the first three pieces of legislation he introduced since taking office. This trio of bills is intended to encourage health quality reforms, build a national health IT infrastructure, and link health care payments to health care quality.

Forum topics included improving patient safety, practice efficiency and pharmacy cost management through e-Prescribing; best practices, lessons learned and barriers from payers, pharmacies, physicians and other stakeholders; and next steps to drive collaborative action to address barriers and accelerate e-prescribing nationally.

The forum concluded with a facilitated discussion of the issues raised during the day, focusing on three key areas of multi-payer collaboration: (1) education of industry stakeholders; (2) metrics, incentives and business models; (3) implementation assistance to ensure success.

View a copy of the e-Prescribing Forum presentations.

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CORE Phase III and HIPAA 5010

CORE is working to ensure that the Phase III rules support version 5010 of the HIPAA standard transactions. In anticipation of the industry moving from 4010 to 5010, CORE included in both its Phase I and Phase II operating rules many of the features found in the X12 5010 TR3s to address the common information needs for patient eligibility. For that reason, CORE rules already incorporate some 5010 requirements - support of service type codes and reporting patient financials are examples. Accordingly, many CORE-certified entities are well-positioned for 5010 implementation.

CAQH provided public comment on the proposed 5010 HIPAA rules in mid-October. View the comment letter to Secretary Leavitt.

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CORE In The News

American Medical Association Endorses CORE, Issues Statement of Support

CAQH recently announced that the American Medical Association (AMA) has endorsed CORE and issued a statement of support for the initiative. The largest physician’s group in the nation will work with CAQH to educate AMA members about the efficiencies that the CORE rules can bring to provider practices. AMA also will help communicate strategies to its members for discussing CORE with their affiliated vendors and health plans.


CAQH Launches CORE Phase II Rules, Creates First-Time National Provider Access to Consistent Patient Deductible Data

In September, CAQH announced that CORE had completed the Phase II rules and that nearly 30 leading health plans, large provider groups and technology vendors have committed to completing Phase II rules certification testing by the end of 2009 or Q1 2010.

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Catalyst is a quarterly CAQH ePublication focused on strategies and best-practices for simplifying healthcare administration.

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