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)
UPD Session Summaries
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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Other CAQH News
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.