Summer 2011
LEAD STORIES

New CAQH Members 

CIGNA and Kaiser Permanente recently joined CAQH as its newest member organizations. With the addition of these organizations, CAQH members now provide healthcare coverage for an estimated 165 million insured lives.

Representatives from each organization are serving on the CAQH Board of Directors. Matt Manders, President, U.S. Service, Clinical and Specialty, is participating as the CIGNA representative. Arthur Southam, M.D., Executive Vice President, Health Plan Operations, Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals is participating as the Kaiser Permanente representative.

Membership in CAQH underscores the commitment of these organizations to reduce administrative cost and eliminate inefficiency from the healthcare system in order to ensure a better overall experience between plans and providers. This broadening participation extends the reach and impact of CAQH as it continues to advance streamlined healthcare administration.

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Provider Data White Paper 

CAQH is currently developing a white paper to capture the current state of provider data, including the challenges and opportunities identified by various stakeholders. While not intended to serve as a comprehensive analysis, the white paper will offer a basis for discussion given the increasing demands for this information.

To offer a forum for industry thought leaders to convene and discuss the topic of provider data, CAQH is planning a Provider Data Summit to be held in December 2011. Interactive sessions will explore cost, quality, and management, with the goal of promoting an industry understanding of the existing and potential needs and uses for provider data.

More details about this White Paper and Summit will be shared in the near future.

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Top Executives in Healthcare IT Recognized 

On June 15, 2011 eMids Technologies and Healthcare Payer News recognized eleven top executives and thought leaders in the healthcare IT industry. The recipients of the honor include several individuals who provide ongoing leadership to CAQH efforts:

  • Jay Eisenstock, Manager of Provider eSolutions – Aetna
  • Chere Parton, Head of Provider eSolutions – Aetna
  • Bill Fandrich, SVP & CIO – BlueCross BlueShield of Massachusetts
  • Brent Antony, CIO – Bureau of TennCare
  • Gwen Lohse, Deputy Director - CAQH
  • Deborah Norton, CIO – Harvard Pilgrim Health System
  • Gus Kairys, Vice President of Provider Relations – Highmark
  • Mark Barnard, SVP – Horizon BlueCross BlueShield of New Jersey
  • Joan Jennerjahn, VP of Provider Operations – Independence Blue Cross
  • Mark Reynolds, CEO – Neighborhood Health Plan of Rhode Island
  • Dave Wichmann, EVP & CFO – UnitedHealth Group

View the press release for more information.

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Annual Report - 2010 Highlights 


The recent CAQH Annual Report provides highlights and accomplishments of the organization and its initiatives during 2010. The report offers insight into CORE developments as the industry transitions into a mandated operating rules environment, as well as the evolving role of UPD as a trusted data source.

View the report online.

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CAQH Welcomes New Staff 

CAQH is pleased to announce the following individuals have joined the CAQH team: Andrew Hooson, Ezra Rosenberg, and Zach Fithian.

Andrew Hooson has joined CAQH as a UPD Sales Associate. He is supporting the goal of increasing overall participation in the Universal Provider Datasource, as well as expanding utilization of UPD SanctionsTrackTM. A graduate of the University of Maryland (UMD) with a B.A. in English, Andrew is continuing his education at UMD where he is pursuing an M.S. in cyber security policy. Andrew may be reached at ahooson@caqh.org or (202) 778-1158.

Ezra Rosenberg, CORE Project Assistant, supports CORE and is conducting research necessary for developing the CORE operating rules - with a focus on EFT and ERA issues. He graduated from Hamilton College with a B.A. in Public Policy and has prior experience interning both on Capitol Hill and in state government. Ezra may be reached at erosenberg@caqh.org or (202) 861-6368.

Zach Fithian is the new CORE Project Associate. He is focusing on research and administration activities that support the CORE operating rules and the work of the CORE Transition Committee. He earned his B.A. from New York University. Zach may be reached at zfithian@caqh.org or (202) 778-3271.

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Upcoming CORE Conferences

(Please click on each event for more information.)

CAQH and WEDI Audiocast;
6/22/11

World Congress Executive Forum and Expo on Healthcare Payment Connectivity Solutions;
7/26 - 7/28/11

MMIS Conference;
7/31 - 8/3/11
Booth 40

9th Annual Health Care Quality Congress;
8/1 - 8/3/11

GE National Users Conference;
8/22 - 8/26/11

Fifth National HIPAA Summit West;
9/20 - 9/22/11

Visit CAQH often to learn of
upcoming events.

New CORE Certifications
 

Health Plans
United Healthcare (Phase I and II)

Providers
Montefiore Medical Center (Phase II)

Vendors/Clearinghouses
Ingenix (Phase I and II) –
Transaction Exchange

Recondo Technology (Phase II) –
SurePayHealth

Endorser
eMids Technologies Inc. (Phase I & II)

New CORE Participants

Allina Health Systems
Allscripts
American Hospital Association
Bank of America
DST Health Solutions
Fifth Third Bank
HBCS
Hospital Corporation of
     America (HCA)
Kaiser Permanente
Minnesota Department of Health
NYU Langone Medical Center
OneHealthPort
The Clearing House
Tufts Health Plan
US Bank
US Department of Treasury
     Financial Management Service

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 120 industry stakeholders collaborating on a set of uniform business rules that are built on existing industry requirements. CORE participating organizations collectively cover more than 150 million lives or approximately 75 percent of the commercially insured, plus Medicare and Medicaid beneficiaries.

Transition Committee 

The Transition Committee has been launched to make recommendations regarding multi-stakeholder governance of CORE. The Committee was formed as part of a 2010 commitment made by the CAQH Board to increase industry participation in operating rules development and adoption. The group is charged to develop a three-year plan that outlines governance structure and revenue models for CORE. Additionally, it will propose ideas for enhancing the current CORE multi-stakeholder approach by increasing participation by states, physicians, hospitals and other healthcare providers. It is anticipated that the Committee will complete its work and implement its recommendations by the end of 2011.

The CORE Transition Committee members represent various stakeholder groups and include senior-level executives from the following organizations:

  • Allscripts
  • America’s Health Insurance Plans (AHIP)
  • American Hospital Association (AHA)
  • American Medical Association (AMA)
  • Blue Cross and Blue Shield of North Carolina
  • GE Healthcare
  • J.P. Morgan
  • Medical Group Management Association (MGMA)
  • Minnesota Department of Health
  • Montefiore Medical Center
  • National Governors Association (NGA)
  • UnitedHealthcare
  • WellPoint, Inc.

More details about representatives and the Committee, which is being facilitated by the CORE Chair, are available online at http://www.caqh.org/CORE_Transition_Committee.php.

Read the CORE Transition Committee release here.

For more information, contact Gwen Lohse at glohse@caqh.org

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UnitedHealth Group Achieves CORE Certification  

UnitedHealth Group recently achieved CORE-certification for its implementation of the CAQH CORE Phase I and Phase II rules. UnitedHealth Group is the first organization to complete certification using an updated testing platform, which builds on non-mandated aspects of the Health Insurance Portability and Accountability Act (HIPAA) version 5010 requirements.

CORE certification verifies that UnitedHealth Group can deliver more predictable patient-eligibility and claims-verification information to physicians, hospitals and other care providers, according to operating rules developed by CORE. The certification will apply to UnitedHealth Group systems covering 37 million members.

A CORE-authorized testing vendor, Edifecs, provided the independent platform to validate that UnitedHealth Group systems operate in accordance with the CORE Phase I and II rules. UnitedHealth Group has its v5010 production transactions in process and will continue to migrate its trading partners to these new systems through the January 2012 deadline.

More than 50 organizations are CORE-certified and have completed testing for the CORE rules. Montefiore Medical Center recently became the first provider group to achieve CORE Phase II certification. Other recent Phase I and/or II certifications include: HealthTrio LLC, Ingenix, Practice Insight, Recondo Technology, The SSI Group, and ZirMed. Organizations that do not exchange eligibility, benefits, and claims status information may endorse CORE. The latest organizations to endorse the initiative include eMids Technologies Inc., FIS Global, HIPAA Ready LLC, and NACHA – The Electronic Payments Association.

Over the last few months a number of new organizations have begun participating in the development of the CORE rules: Allina Health System; Allscripts; American Hospital Association; Bank of America; Cognosante (Fox Systems); Deloitte Consulting LLP; DST Health Solutions; Fifth Third Bank; FIS Global; HBCS; HERAE, LLC; Hospital Corporation of America; Hubbert Systems Consulting; Kaiser Permanente; Minnesota Department of Health; NYU Langone Medical Center; OptumHealth Financial Services; OneHealthPort; The Clearing House; Tufts Health Plan; US Bank; US Department of Treasury Financial Management Service; and VeriSign, Inc. – a Symantec Business. More than 120 multi-stakeholder organizations are participating in the collaboration.

For information how your organization can achieve CORE Phase I or II certification, contact Erin Richter at erichter@caqh.org. Read the UnitedHealth Group release here.

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Rules Updated for HIPAA v5010  

The federal mandate deadline for adoption of HIPAA Version 5010 standards is January 1, 2012. Per the CORE guiding principles, CORE operating rules are updated to coordinate with federally mandated requirements. The voluntary CORE Phase I and Phase II policies and rules have been updated to reflect HIPAA v5010 requirements and associated errata. A summary of the changes, as well as each of the adjusted CORE rules, is available on the CAQH website: http://www.caqh.org/COREv5010.php.

For questions pertaining to the CORE rules and HIPAA v5010, please contact Bob Bowman at rbowman@caqh.org.

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EFT-ERA White Paper 

In collaboration with NACHA, CAQH recently issued a white paper examining the adoption of electronic funds transfer (EFT) and electronic remittance advice (ERA) by health plans and providers. The paper is based on research conducted to better understand the current status of government, health plan and provider use of EFT and ERA, and to facilitate development of robust EFT and ERA operating rules.

The findings explore barriers to industry-wide, rapid adoption of EFT and ERA, as well as initial recommendations on topics that operating rules and other industry efforts must address in order to facilitate adoption. The details behind these findings are being presented to the CORE EFT and ERA Subgroups as they develop healthcare operating rules; the financial services industry is also considering the findings as it amends the NACHA Operating Rules for EFT.

The white paper is available online at http://www.caqh.org/Host/CORE/EFT-ERA/WhitePaper.pdf.

Contact Erin Richter at erichter@caqh.org with any questions.

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National Operating Rules Update 

Section 1104 of the Patient Protection and Affordable Care Act (ACA) requires the Health and Human Services (HHS) Secretary to adopt and regularly update standards, implementation specifications, and operating rules for the electronic exchange and use of health information for the purposes of financial and administrative transactions. The ACA requires the National Committee on Vital and Health Statistics (NCVHS) to make recommendations regarding operating rules to the HHS.

EFT and ERA
On March 23, 2011, NCVHS sent a letter to Secretary Sebelius, HHS, making a recommendation to name "CAQH CORE in collaboration with NACHA as the candidate authoring entity for operating rules for all healthcare EFT and ERA transactions..."

The letter also recommends that the Secretary:

  • Require CAQH CORE, in collaboration with NACHA, submit to NCVHS fully vetted Electronic Funds Transfer (EFT) and Health Care Payment and Remittance Advice (ERA) operating rules for consideration by the Committee by August 1, 2011.
  • Require CAQH CORE to establish mechanisms for greater direct engagement of X12, NCPDP, HL7 and other standards development organizations (SDOs) in order to support a more open, collaborative and multi-stakeholder consensus process.
  • Call on X12, NCPDP, HL7 and other SDOs to actively engage with CAQH CORE and to provide timely input and feedback on EFT and ERA operating rules.
  • Further clarify the scope, focus, and limitations between operating rules and standards.
  • Require CAQH CORE to identify more effective means to engage greater and broader provider participation and input.

In response to the March 23rd recommendations, CORE participants are working diligently towards the August 1, 2011 deadline to develop EFT and ERA operating rules. Discussions have started to determine the potential rule opportunity areas based on:

  • The scope of operating rules as defined by ACA Section 1104; e.g., build upon existing standards.
  • Existing activities that showcase current priorities; e.g., CAQH CORE and NACHA research, draft CAQH CORE rules, current state efforts (e.g., MN State Administrative Uniformity Committee, WA State Healthcare Forum) and work done by key collaborators like ASC X12 and WEDI.

A public survey was issued to gain more industry input about which areas are best to pursue. Over 115 organizations completed the survey. The findings are helping to inform the EFT and ERA Subgroup on how to focus efforts given the criteria used for CORE rule writing, e.g.:

  • Remain within the scope of the operating rules as defined by ACA Section 1104.
  • Support CORE Guiding Principles; e.g., align with Federal HIT efforts.
  • Balance between anticipated industry benefit relative to the industry adoption cost (ROI).
  • Can be developed within the NCVHS time frame (08/01/11 deadline).

Seven high priority areas have been selected, and rule approaches have been selected for the majority of these areas.

For more information on the CAQH CORE operating rules for EFT and ERA, contact Erin Richter at erichter@caqh.org.

Eligibility and Claim Status
Given the NCVHS recommendation on September 30, 2010 for CAQH CORE to consider potential enhancements to the Phase I and II rules, CAQH staff collected suggestions from states, providers and other key stakeholders on potential enhancements from October, 2010 through the end of the year. Additional feedback was solicited from CORE and non-CORE participants via an open survey and “Tiger Team” calls. (View a summary of the survey results or a high-level summary of the discussions.) The appropriate CORE Subgroups and Work Groups then met to discuss the potential enhancements to the Phase I and II CORE rules based on the NCVHS recommendation.

Per the CORE voting process, both the Rules and Technical Work Groups held ballots on potential enhancements to the CORE rules. The Work Groups approved enhancements to the CORE Phase II rules based on three Phase III draft rules:

  • Use of 277CA for acknowledging v5010 837 claims.
  • Uniform use of claims status category and claims status codes.
  • Replace 997 Functional Acknowledgement with 999 Implementation Acknowledgement.

All CORE rules that are not included in packages for potential mandates due to timing constraints and/or other regulatory parameters will be supported by CORE via a voluntary certification process.

NCVHS: April 27, 2011 Testimony
On April 27, 2011, the NCVHS Subcommittee on Standards heard testimony from numerous organizations on "The Acknowledgment Transaction Standard and Maintenance and Modifications to Standards and Operating Rules (the present and the future)".

Acknowledgements:
Based on its experience, CAQH CORE provided testimony about standard acknowledgement transactions. CAQH CORE highlighted the opportunity being provided by Section 1104 of the ACA for the industry to drive national adoption of consistent use of acknowledgements through mandated operating rules.

Since its inception, the CORE rules have and continue to require acknowledgements. As the CORE operating rules are developed in phases, each set of rules complements the others by recognizing interdependencies. This approach is essential when considering acknowledgements. For example, if operating rules require real-time response to an inquiry, an acknowledgement of the same inquiry is not necessary and, in fact, could add unnecessary costs to the system given vendor fees and provider work flow resources related to acknowledgements.

Modifications:
Regarding current maintenance and modifications for standards and operating rules, CAQH CORE described four inter-related themes that define what is working and what can be improved.

  1. The rapidly changing world of HIT for administrative simplification must support vision for innovation and cost reduction –alignment on key tools and milestones.
  2. Strong governance and solid funding are both critical in order to guide what must be modified and maintained; leadership is key.
  3. Tactical processes for updating operating rules must be guided by the strategic vision and governance.
  4. Consistent, yet iterative, coordination will be needed between authoring entities for operating rules and SDOs.

Before concluding, CAQH CORE highlighted the concept that operating rules can come before or after a version of a standard, emphasizing that this is already occurring and the result is more robust adoption of electronic transactions.

Visit http://www.ncvhs.hhs.gov/110427ag.htm for a presentation and audio archive of the Acknowledgements and Modifications testimony.

Voluntary CORE Rules
Work on developing voluntary CORE operating rules continues. Following the release of nationally mandated operating rules, CORE will determine which of its draft voluntary rules are appropriate for voluntary certification. A summary of CORE Phase III draft rules may be found at http://www.caqh.org/CORE_phase3.php.

For more information on CORE operating rules, please contact Erin Richter at erichter@caqh.org.

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EFT and ERA Subgroup Chairs 

Four industry leaders are co-chairing the CAQH CORE EFT and ERA Subgroup. The chairs represent provider, bank, vendor and health plan organizations and are helping guide the discussions and efforts being pursued by the Subgroup.

  • Doug Downey is assistant vice president in treasury at HCA, one of the first U.S. hospital companies. Much of his work has focused on streamlining the payment process.
  • Stuart Hanson is vice president, healthcare solutions product line manager for Fifth Third Bank. He has a background in medical banking at multiple financial services organizations.
  • Tom Turi is senior vice president of financial services with Emdeon Business Services. He has worked to transform financial business processes across multiple industries.
  • Peter Walker is the manager of Provider eServices at Aetna, Inc. His background includes experience providing direction for the creation and maintenance of electronic transactions used by healthcare providers.

For more information about the efforts of the EFT and ERA Subgroup, contact Omoniyi Adekanmbi at oadekanmbi@caqh.org.

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Education Opportunities 

Presentations and Participation at Industry Conferences
Outreach and education are an essential component of the CORE integrated model. CORE representatives regularly speak at healthcare events to help inform the industry about the role of operating rules and how the changing environment is impacting CORE efforts. View a list of upcoming presentations.

Town Hall Calls
Additionally, CAQH CORE is holding open Town Hall Calls every four-to-six weeks which all stakeholders, both CORE participating and non-participating entities, are invited to attend. The purpose of these calls is to provide an informal update on CORE activities over recent weeks and months. More information and the Town Hall call schedule are available online.

Educational Sessions
CAQH CORE also offers several online education events through webinar and audiocast presentations. Many of these e-learning opportunities are in collaboration with other industry leaders, such as the American Medical Association (AMA); Edifecs, a CORE-authorized testing vendor; NACHA – The Electronic Payments Association; and the Workgroup for Electronic Data Interchange (WEDI). Visit www.caqh.org/CORE_Education_Events.php to view an archive of these presentations.

Contact Ezra Rosenberg at erosenberg@caqh.org for more details on these education opportunities.

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UPD STATS AT A GLANCE

UPD is the industry standard for self-reported provider data collection. On average, 7,000 providers join the service each month.

Totals as of June 16, 2011:

Providers Using UPD to Reduce Administrative Costs:
927,821

Annual Administrative Savings:
$109 million (3.7 million hours)

Paper Applications Eliminated Since Service Inception:
2.8 million

Environmental Impact:
Estimated 97 million pieces of paper or 11,750 trees


NEW UPD PARTICIPANTS

1199SEIU
Beth Israel Deaconess Provider
    Organization
Blue Cross of Northeastern
    Pennsylvania
Century PHO
Ceridian Corporation
Compass IPA
Concordia Behavioral Health
Dentaquest
Driscoll Children's Health Plan
Family Health Network
First Care Health Plans
Florida Healthcare Plus/Gold
    Coast Health Plan
Gold Coast Health Plan of Ventura
    County
Great Lakes Health Plan
HealthSpan
Illini Care Health Plan Incorporated
    (Centene)
Inspiris
Kingman Regional Medical Center
Nationwide Childrens Hospital
Pinehurst Medical Clinic
Platinum Physician Services
Scion Dental
TennCare
The Health Plan
TriState Health Partners
Vohra Health Services

Launched in 2002 by CAQH, the Universal Provider Datasource® (UPD) is achieving its vision of simplified credentialing by reducing paperwork and millions of dollars of annual administrative costs for more than 927,000 providers and over 600 health plans and hospitals across the United States.

More Than 927,000 Providers Registered with UPD 

As of June 16, 2011, the number of providers using the UPD service has increased to more than 927,000, firmly establishing UPD as the go-to resource for timely and accurate self-reported data from physicians and other healthcare professionals. Approximately 7,000 additional providers continue to input their information into UPD every month.

With interest in streamlining provider data collection, maintenance and distribution growing, adoption of UPD as a trusted data source continues to increase as well. Organizations are exploring ways that UPD can address provider data needs beyond credentialing, such as claims administration, quality assurance, directories and more.

Read the UPD 900,000 Providers press release.

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Shelly Ferensic, Chair, UPD 

CAQH is pleased to announce the appointment of Shelly Ferensic as the new chair of the UPD initiative. She assumes this responsibility from Kurt Small, vice president, head of Medicare service operations of Aetna, who contributed his expertise in this role for four years. In her role as UPD chair, Ferensic will help shape future directions for the UPD initiative.

Ferensic has more than 15 years of experience leading health plan operations. She joined Aetna in 1999 through the acquisition of Prudential HealthCare, where she headed National Accounts customer service and claims operation in Stockton, California.

Currently the vice president and head of Claim and Provider Service Operations at Aetna, she oversees claim processing operations. Additionally, Ferensic manages all facets of service for physicians, hospitals and other health care professionals, including customer service, claim rework, provider contract loading and demographic data management, and credentialing.

Ferensic holds a bachelor’s degree in English and Education from Indiana University, and a master’s degree in Organizational Leadership from Gonzaga University. She is a fellow with the Life Management Institute and an Associate of Life and Health Claims with the International Claim Association.

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Tutorial 

A Flash tutorial on the CAQH UPD is now available. In the five-minute tutorial, healthcare practitioners can observe basic instructions on how to complete the UPD application from start to finish. This new user-friendly reference is intended to further improve data quality, reduce application errors, and eliminate provider frustrations.

View and share the UPD tutorial http://caqh.org/upd_tutorial.php.

Note: Viewing the tutorial requires Adobe Flash Player (click here for free download).

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Provider Data Study 

Widespread adoption of UPD by both providers and participating organizations has led to opportunities to leverage UPD beyond its original vision to simplify credentialing. CAQH has engaged The Nolan Group to conduct research and explore the concept of utilizing UPD for provider data needs throughout participating organizations.

The Nolan Group is measuring current enterprise costs of provider data collection and maintenance, as well as potential savings via UPD. The study uses a sample of two national and two regional health plans. The research is assessing key processes and interactions used to acquire, manage, and use provider data in health plan operations, as well as looking at potential savings that health plans can achieve by expanded use of UPD.

Findings will help articulate the expanded UPD value proposition and provide insight into information that would be helpful to organizations trying to understand the applicability of UPD to their own provider data needs.

CAQH will be sharing highlights of the study in Q3-2011.

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Simplifying Medicaid Agency Provider Data Collection 

UPD offers its simplified provider data collection solutions to state Medicaid agencies. Most recently, TennCare, the Tennessee Medicaid program, contracted with CAQH to use UPD for its provider enrollment and credentialing needs. The contract also allows for the option of utilizing UPD as the source of provider-related data for the state health information exchange (HIE) directory and emergency registration repositories. Kentucky, New York, and Pennsylvania Medicaid agencies are also using UPD. Read the TennCare press release.

Additionally, UPD is supporting Medicaid adoption of its services through a partnership with eServices Group. Using a new interface for Medicaid provider data collection, data from UPD can be retrieved real-time through Medicaid IT Architecture (MITA)-aligned services. Users can also receive alerts to possible license sanctions, which could help reduce Medicaid fraud and abuse.

More information about the utility of UPD for state Medicaid agencies is available in an informational CAQH brochure, entitled “UPD - Simplifying Medicaid Agency Provider Data Collection.” State Medicaid and healthcare information exchange representatives focused on Medicaid enrollment are invited to download a copy.

For details on how UPD can streamline provider data collection for Medicaid contracted providers, contact Christine Stroup at cstroup@caqh.org.

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HIE Provider Directories 

CAQH and the eHealth Initiative (eHI) recently conducted a national online survey to understand the specific data required to fully support HIE provider directories. More than seventy HIE experts from across the U.S. responded to the survey over a 10-day period in the fourth quarter of 2010.

High-level highlights from the study include:

  • Health information exchanges recognize the need to maintain provider information in directories. Respondents reported that data about individual providers is required or strongly desired for a provider directory; additional desired data elements varied among respondents (i.e. practice name, location, telephone, email address etc.).
  • Heath plans and state Medicaid agencies are the best sources of provider information. Respondents ranked health plans, followed by state Medicaid agencies, as the most authoritative sources of provider data for provider directories.
  • Frequent provider updates are critical to keeping provider directories relevant. The majority of respondents preferred daily, weekly, or monthly updates.
  • Providers need to be directly involved in updating their data. Almost all respondents (93.2%) advocated direct provider involvement as very or somewhat important in their data updates.
  • Providers should control use of their data in provider directories. A majority of respondents (about 7 in 10) reported that providers should control secondary use of their data in an HIE provider directory.
  • HIE experts reported numerous applications of HIE provider directories. Primary applications include: 1) meaningful use, 2) interoperability, 3) foundational, and 4) collaboration.

The findings have broad relevance to directory development and maintenance. Responses can help inform HIEs, vendors, and statewide efforts. UPD, with eHI, shared the results of this joint survey in follow up to testimony provided to the HHS Office of the National Coordinator, HIT Policy Committee Information Exchange Workgroup, Provider Directory Task Force.

The detailed survey results are available online: http://www.caqh.org/Host/UPD/Survey_HIEProviderDirectory.pdf.

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System Enhancements Update 

During the third quarter of 2010 UPD published a landmark report establishing an industry baseline on the quality of provider self-reported data used for credentialing and other administrative purposes. A UPD Work Group is responding to these findings by recommending a number of system enhancements designed to make the data collection and attestation process faster and easier for everyone involved. UPD data quality is expected to improve with clear instructions and streamlined processes that further support timely attestation and information updates.

UPD has outlined a work plan to implement system enhancements over the next several years. New functionality and updates have already begun and are easing the use of UPD for physicians and other healthcare practitioners inputting data into the system. The enhancements are also providing greater value to participating health plans by ensuring improved data consistency, more accurate data entry and attestation, refined data logic, alignment with state-specific credentialing forms or standards, and submissions of unexpired provider data.

The UPD Work Group is currently focused on review and prioritization of a second round of system enhancements. Participating organizations will be notified of relevant system enhancements as they roll out. UPD Account Managers are available to respond to questions. Comments or suggestions on overall UPD system enhancements may be addressed to Sorin Davis, sdavis@caqh.org.

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