Price Transparency

CAQH CORE: Establishing the Building Blocks of Price Transparency 


     The healthcare industry has seen several laws and regulations related to price transparency over the last years, including the Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Rule, CMS Transparency in Coverage Rule, the No Surprises Act, and related regulations. The purpose of these policies is to increase consumer awareness of the cost of care and limit surprise billing practices. 

Improving Health Plan Provider Directories

More than half of patients use health plan provider directories to find an in-network clinician that is right for them. Despite industry efforts, however, directory inaccuracies have been a persistent challenge. When directory information is incorrect, patients can be inconvenienced and face financial consequences. To address these issues, policymakers at the federal and state levels are requiring health plans and practices to put processes in place to improve provider directory data.

Current Initiatives for CAQH CORE Participants

CAQH CORE Participating Organizations help ensure that operating rules continue to meet evolving business needs, by engaging in the rule development process and maintenance of existing operating rules. Work groups are open to all CAQH CORE Participating Organizations, and multiple individuals from the same Participating Organization may join. Because each organization has only one vote, participants collaborate with their colleagues to submit an organizational-level response during voting periods.