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.
Attributed Patient Rosters are used by health plans, providers and employers to share lists of patients attributed to a provider under a value-based contract. The CAQH CORE Attributed Patient Roster Operating Rules establish consistent expectations for the electronic exchange of attributed patient rosters among stakeholders at predictable intervals by supporting consistent data content, infrastructure and a connectivity safe harbor using the X12 005010X318 Member Plan Reporting (834) Transaction.
CAQH CORE has updated its operating rule structure. The CAQH CORE FAQs are in the process of being updated to align with the new structure. CAQH CORE appreciates your patience as these updates are made.
CAQH CORE has produced a variety of online resources to provide education on operating rule implementation and CAQH CORE initiatives.
CAQH CORE has developed interactive tools and dashboards on topics of interest to industry stakeholders.
CAQH CORE will provide an update of its work efforts and priority initiatives to deliver administrative efficiency and value to the healthcare industry.
Register for this Town Hall to engage with CAQH CORE and provide input on how to best drive the industry towards fully digital business operations. For any questions, please contact CAQH CORE staff at CORE@caqh.org.
CAQH CORE will provide an update of its 2020 Goals and priority initiatives to deliver administrative efficiency and value to the healthcare industry. Topics will include:
CAQH CORE, together with Cleveland Clinic and PriorAuthNow (PAN), is pleased to share initial findings highlighting the impact of greater prior authorization (PA) automation and workflow integration leveraging standards and operating rules at Cleveland Clinic. The Cleveland Clinic will share how the implementation of an integrated PA solution is improving the ability of staff to conduct PAs and creating a more efficient process.
Beginning in July 2000, the founding CAQH members launched a series of initiatives to improve the quality of healthcare and reduce administrative burdens for physicians, patients and payers. These first programs were designed by work groups of health plan and CAQH staff, developing tools and technologies to support physicians and educate patients about vital health issues and insurance benefits.
While today CAQH is focused on streamlining business challenges, some of the early initiatives addressed clinical issues. Here are a few examples:
What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?
Each year, CAQH publishes a report that tracks the progress the healthcare industry is making toward automating business transactions. For example, the 2019 CAQH Index found that the medical and dental industry could save an additional $13.3 billion dollars annually by automating administrative transactions.
This research is made possible through the voluntary participation of stakeholders from across healthcare.