Frequently Asked Questions
The CAQH CORE FAQs are in the process of being updated. CAQH CORE appreciates your patience as these updates are made.
Public
Resource Library
CAQH CORE has produced a variety of online resources to provide education on operating rule implementation and CAQH CORE initiatives.
e-LEARNING RESOURCES
CAQH CORE has developed interactive tools and dashboards on topics of interest to industry stakeholders.
CAQH CORE Town Hall
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 September Town Hall
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:
Prior Authorization Automation Case Study Webinar with Cleveland Clinic, PriorAuthNow and CAQH CORE
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.
How It All Began
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:
Health Outcomes.
An Interview with Sorin Davis, Senior Vice President, Industry Relations
What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?
CAQH Recognized as Best Place to Work Five Years in a Row
For the fifth consecutive year, CAQH, an industry alliance working to streamline the business of healthcare, has been named one of the “Best Places to Work” by Modern Healthcare.
SSI Group, Availity Achieve Additional CAQH CORE Certifications
SSI Group and Availity, two leading revenue cycle management companies, are the latest organizations to achieve new CAQH CORE Certifications. Both are now CAQH CORE-certified for Prior Authorization & Referrals (infrastructure). Availity also achieved certification for Health Care Claims. Previously, both SSI and Availity were CAQH CORE-certified for Eligibility & Benefits, Claim Status and Payment & Remittance.
Ensuring Accurate Coordination of Benefits During Remote Work
Managing coordination of benefits (COB) is challenging for many health plans, but Medicaid plans face among the greatest obstacles. For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly. These plans also have limited resources for identifying third-party liability, although they are required by law to do so.
And now, as team members involved in COB work remotely, these hurdles can become even greater.
