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Member Data Solutions for State Medicaid Programs
CAQH Member Data solutions help Medicaid programs improve enrollment, eligibility, coordination of benefits and enrollee services.

A registry of coverage information on 250 million people, updated weekly.

Every national health plan and many federal and state programs contribute to and update the registry. We use this to enable Medicaid programs to automate and streamline operations and lower costs.

Improved enrollee services

Programs can quickly identify if members have third party coverage, either through commercial plans or other government programs, make quick and accurate eligibility determinations and answer questions. By reducing the need for enrollee outreach and claims denials, CAQH eliminates costly manual processes and reduces member abrasion.



Simplified Administration

The solutions integrate with existing Medicaid management systems to simplify implementation and streamline information exchange. With a per member fee, budgeting in predictable and the return on investment is clear.  The unique payer-to-payer communications feature enables programs to collaborate directly with other programs and plans to improve the accuracy and efficiency of eligibility, enrollment and coordination of benefits. 



Lower costs

CAQH member data solutions may be the most accurate and efficient way to coordinate benefits and manage third party liability.  By allowing them to identify other coverage before claims are paid, we help programs avoid millions of dollars in costs and reduce their reliance on costly recovery efforts.

Improved Eligibility Determinations

When the public health emergency ends, Medicaid leaders will be required to perform eligibility redetermination for nearly 85 million people over a 9 to 14 month period of time. 


The CAQH coordination of benefits solution provides programs a file every week with an analysis of coverage overlap of its enrollees. The analysis includes demographic and contact information, coverage types, plan names, dates of coverage and payer payment responsibility.


This information can then be used for a range of eligibility, benefit coordination, payment and enrollee outreach activities. For complex or undetermined coverage cases, payers have access to a secure payer-to-payer messaging system to share documents and resolve data or coverage issues.

Supporting the Mission

CAQH solutions transform eligibility, enrollment, coordination of benefits and third party liability processes for Medicaid programs.