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.
CAQH CORE will be playing an active role in this year’s WEDI Forum, and leading two sessions during the three-day event:
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.
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For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly.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.
Now that states have started the process of reopening and our healthcare system is beginning to return to normal operations, this is an ideal time for providers to make sure their professional and practice information in CAQH ProView is up to date.
CAQH CORE is hosting a series of interactive webinars to give healthcare leaders an opportunity to engage and collaborate during this time of social distancing.
Connectivity is essential for successful interoperability as it enables the transport of information to support data exchange. To address the industry’s need to align on a common set of communication protocols, CAQH CORE maintains a set of operating rules addressing connectivity and security of data exchange. CAQH CORE Participating Organizations are currently evaluating updates to the CAQH CORE Connectivity requirements to address existing and emerging standards and protocols to support the intersection of administrative and clinical data exchange.
On June 23, CAQH CORE staff will host a panel discussion featuring CAQH CORE Board members centered on key industry topics, including value-based payments, interoperability, and COVID-19.
Dr. Sue Turney (MGMA) President and CEO, Marshfield Clinic Health System
Tim Kaja Chief Operating Officer of UnitedHealth Networks, UnitedHealthcare
Dr. Marilyn Heine (AMA) Clinical Assistant Professor of Medicine, Drexel University College of Medicine
The Premium Payment (820) transaction provides the format for transmitting information relating to payments. The CAQH CORE Premium Payment Operating Rules support consistent infrastructure and a connectivity safe harbor across the industry.