Article https://www.caqh.org/ en 2020 CAQH Index: Automating Healthcare Administrative Transactions Has Reduced Annual Costs by $122 Billion, $16.3 Billion More Can Be Saved Through Further Automation https://www.caqh.org/about/newsletter/2021/2020-caqh-index-automating-healthcare-administrative-transactions-has-reduced <span>2020 CAQH Index: Automating Healthcare Administrative Transactions Has Reduced Annual Costs by $122 Billion, $16.3 Billion More Can Be Saved Through Further Automation</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 02/03/2021 - 15:21</span> <div class="field field--name-field-subtitle field--type-text-long field--label-hidden field--item"><h2><p>The annual report tracks trends in automation, spending and savings opportunities for healthcare administrative transactions. </p> </h2></div> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">February 2021</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span>CAQH has released the eighth annual report measuring the progress made by healthcare payers and providers in automating administrative transactions. The<a href="https://www.caqh.org/sites/default/files/explorations/index/2020-caqh-index.pdf"> </a><a href="https://www.caqh.org/sites/default/files/explorations/index/2020-caqh-index.pdf"><span>2020 CAQH Index</span></a> found that, of the $372 billion widely cited as the cost of administrative complexity in the US healthcare system, the industry can save $16.3 billion by fully automating nine common transactions. This savings opportunity is on top of the $122 billion in costs the healthcare industry has avoided by streamlining administrative processes. Levels of automation have increased for both the medical and dental industries since the last report, while the opportunity for further savings has also risen by $3 billion annually. This is largely due to a drop in costs for automated processes and higher costs for manual and partially electronic portal processes alongside increasing volumes.</span></span></span></p> <p><span><span><span>The <a href="https://www.caqh.org/sites/default/files/explorations/index/2020-caqh-index.pdf"><span>CAQH Index</span></a> tracks automation, spending and savings opportunities for administrative transactions related to verifying patient insurance coverage and cost sharing, obtaining authorization for care, submitting claims and supplemental information and sending and receiving payments. The report categorizes transactions by whether they are fully automated, partially electronic or manual. The 2020 Index collected data from health plans and providers through the 2019 calendar year and thus excludes the impact of COVID-19 on healthcare administrative transactions.</span></span></span></p> <p><span><span><span>While the industry has already avoided $122 billion annually by automating these transactions, up $20 billion from last year, the Index pinpointed opportunities for additional savings. For example, each fully automated claims status inquiry costs $11.71 less than the same transaction conducted manually for the medical industry and $10.92 less for the dental industry. Similarly, every eligibility and benefit verification converted from manual to electronic saves the medical industry $8.64 and the dental industry $8.75. Considering the millions of times these transactions occur every day, the savings potential across the healthcare economy is significant.</span></span></span></p> <p><span><span><span>The <a href="https://www.caqh.org/sites/default/files/explorations/index/2020-caqh-index.pdf"><span>2020 Index</span></a> also revealed that the costs associated with some manual and partially electronic portal transactions are increasing. This may be because, as healthcare business needs become more complex, manual processes to accommodate them are becoming more labor intensive and expensive. This further suggests that updates are needed to electronic transactions to address increasingly complex business needs that are today being addressed outside of the standard transactions.</span></span></span></p> <p><span><span><span>To read the full 2020 CAQH Index, <a href="https://www.caqh.org/sites/default/files/explorations/index/2020-caqh-index.pdf"><span>click here</span></a>.</span></span></span></p> <p><a href="https://go.caqh.org/l/339361/2021-01-20/2jrdjt">Register</a> for a CAQH webinar discussing these findings being held on February 10th, 2021 at 2:00 pm ET.</p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> Wed, 03 Feb 2021 20:21:16 +0000 mnew@caqh.org 3162 at https://www.caqh.org Current Initiatives for CAQH CORE Participants https://www.caqh.org/core/current-initiatives-caqh-core-participants <span>Current Initiatives for CAQH CORE Participants</span> <span><span lang="" about="/users/cmassiecaqhorg" typeof="schema:Person" property="schema:name" datatype="">cmassie@caqh.org</span></span> <span>Thu, 01/14/2021 - 20:15</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>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. </p> <p>Below is a list of CAQH CORE work groups that currently convene or are upcoming as well as initiatives that are underway. In addition to contributing to these work groups and initiatives, as well as the formal CAQH CORE <a href="https://www.caqh.org/core/voting-process"><span>voting process</span></a>, Participating Organizations benefit from exclusive education content and research opportunities.</p> <table border="0" cellpadding="0" cellspacing="0" width="610"><tbody><tr><td> <p><span>Initiative </span></p> </td> <td> <p><span>Focus</span></p> </td> <td> <p><span>Current Objectives</span></p> </td> <td> <p><span>Co-Chairs</span></p> </td> <td> <p><span>Cadence</span></p> </td> </tr><tr><td><strong><span><span><span><span>Eligibility &amp; Benefits Task Group</span></span></span></span></strong></td> <td>Rule Development</td> <td>Update the Eligibility &amp; Benefits Data Content Rule to <strong>address emerging industry needs</strong> (such as support more STC codes, tiered benefits, procedure-level, # of remaining visits/services, telemedicine).</td> <td> <p><strong>Meg Soccorso</strong><span> Cigna</span></p> <p><strong>Molly Reese</strong><span><span> </span></span><span><span>AMA</span></span></p> <p><strong>Nora Illuri</strong> athenahealth</p> <p><b>Donna Campbell</b> HCSC</p> </td> <td> <p> </p> <p>Monthly, adjourning September 2021</p> </td> </tr><tr><td> <p><strong>Pilot &amp; Measurement Initiative</strong></p> </td> <td> <p>Prior Authorization &amp; Attachments; Quality Measures Reporting</p> </td> <td> <p><span class="normaltextrun"><span>Work with other CORE Participating Organizations and CAQH to <b>measure the impact of potential operating rules and corresponding standards on entities’ efficiency metrics.</b></span></span></p> </td> <td> <p>N/A</p> </td> <td> <p>Ongoing</p> </td> </tr><tr><td><strong><span>Advanced EOB Advisory Group</span></strong></td> <td><span>Guidance Development</span></td> <td> <p class="paragraph"><span style="font-size:11pt"><span style="vertical-align:baseline"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:#444444">Charged with developing guidance document illustrating <strong>how industry can meet Advanced EOB requirements in the No Surprises Act</strong>, leveraging uniform framework and industry standards, with a focus on the exchange of Good Faith Estimates. Recommendations from the guidance documents could be developed into operating rules in the future.</span></span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">​</span></span></span></span></span></span></p> .</td> <td> <p>N/A</p> </td> <td> <p><span>Meets monthly<strong> </strong>through Fall 2021</span></p> </td> </tr><tr><td><strong>Review Work Group (RWG)</strong></td> <td>Rule Development</td> <td>Following the conclusion of the Attachments Subgroups, the <strong>RWG will further review and refine both Draft Attachments Operating Rule Sets </strong>to ensure uniformity and cohesion across use cases. Additionally the RWG will review the Draft Eligibility and Benefits Data Content Rule Update prior to the launch of the Final CAQH CORE Vote.</td> <td>TBD</td> <td><strong>Launching Q3</strong>, Meeting Monthly through Q4</td> </tr><tr><td> <p><strong>CORE <u><a href="https://www.caqh.org/core/ongoing-maintenance-core-code-combinations">Code Combinations</a></u> Task Group</strong></p> </td> <td> <p>Rule Maintenance</p> </td> <td> <p>Ensure compliance with the <strong>base standard code lists – CARCs and RARCs</strong>. Conduct annual industry survey to collect suggestions for potential market-driven adjustments to code combinations.</p> </td> <td> <p><strong>Shannon Baber</strong> UW Medicine          <strong>Nathan Fisk</strong> Change Healthcare        <strong>Lynn Franco</strong>  UnitedHealth Group  <strong>Heather Morgan</strong>  Aetna</p> </td> <td> <p>Once every 2-3 months, for a total of 6 times a year</p> </td> </tr></tbody></table><p> If you would like to join any of the following initiatives, please contact <a href="mailto:core@caqh.org">core@caqh.org</a>.  </p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-organization-type field--type-entity-reference field--label-inline"> <div class="field--label">Organization Type</div> <div class="field--item"><a href="/organization/health-plans" hreflang="en">Health plans</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/core" hreflang="en">CORE</a></div> </div> Fri, 15 Jan 2021 01:15:04 +0000 cmassie@caqh.org 2207 at https://www.caqh.org Frequently Asked Questions https://www.caqh.org/core/frequently-asked-questions-1 <span>Frequently Asked Questions</span> <span><span lang="" about="/users/caqhadmin" typeof="schema:Person" property="schema:name" datatype="">caqh_admin</span></span> <span>Tue, 01/12/2021 - 13:24</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><strong><em><span>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.</span></em></strong></p> <p>Implementation of the CAQH CORE Operating Rules for Eligibility &amp; Benefits, Claim Status and Payment &amp; Remittance is <a href="http://www.caqh.org/core/operating-rules-mandate">mandated</a> for all HIPAA-covered entities by the ACA (with the exception of requirements pertaining to acknowledgments). Implementation of the CAQH CORE Operating Rules for Prior Authorization &amp; Referrals, Health Care Claims, Benefit Enrollment and Premium Payment is currently voluntary. HHS will determine whether the voluntary CAQH CORE Operating Rules will be included in any future regulatory mandates. CAQH CORE offers <a href="http://www.caqh.org/core/core-certification-process">CORE Certification</a> for all the CAQH CORE Operating Rules</p> <p>CAQH CORE has developed Frequently Asked Questions (FAQs) addressing all of the CAQH CORE Operating Rules, general CAQH CORE information, CORE Certification and future development of operating rules. You may find your FAQ by clicking on the links below or using the search bar above to identify key words.<o p=""></o></p> <p><o p=""></o></p> <p><strong>NOTE:</strong> The CAQH CORE FAQs are for informational purposes only; in the case of a discrepancy between this document and CAQH CORE Operating Rule text and/or Federal regulations, the latter take(s) precedence. No adjustments to CAQH CORE rule requirements will be made via the FAQ process.<o p=""></o></p> <div class="accordion"> <h3>part a: General CAQH CORE FAQs</h3> <div> <p><a href="/faq-page/492" target="_blank">I. Overview of CAQH CORE</a></p> <p><a href="/faq-page/500" target="_blank">II. Introduction to CAQH CORE Participation</a></p> <p><a href="/faq-page/502" target="_blank">III. CAQH CORE Resources and Links</a></p> <p><a href="/faq-page/560" target="_blank">IV. General CAQH CORE Operating Rules</a></p> </div> <h3>part b: ACA Section 1104 Mandate for Federal Operating Rules</h3> <div> <p><a href="/faq-page/503" target="_blank">I. Overview: ACA Section 1104 Provisions for Federal Operating Rules</a></p> <p><a href="/faq-page/504" target="_blank">II. Requirements for Federal Operating Rules Addressing the Eligibility &amp; Benefits and Claim Status Transactions</a></p> <p><a href="/faq-page/505" target="_blank">III. Requirements for Federal Operating Rules Addressing the Payment &amp; Remittance Transactions</a></p> </div> <h3>part c: CAQH CORE Eligibility &amp; Benefits Operating Rules</h3> <div> <p>I<a href="/faq-page/506" target="_blank">. Overview of CAQH CORE Eligibility &amp; Benefits Operating Rules</a></p> <p><a href="/faq-page/507" target="_blank">II. Interdependent CAQH CORE Eligibility &amp; Benefit Requirements</a></p> <p><a href="/faq-page/512" target="_blank">III. CAQH CORE Eligibility &amp; Benefits (270/271) Infrastructure Rule</a></p> <p><a href="/faq-page/519" target="_blank">IV. CAQH CORE Eligibility &amp; Benefits Data Content (270/271) Rule</a></p> <p><a href="/faq-page/509" target="_blank">V. CAQH CORE Eligibility &amp; Benefits (270/271) Single Patient Attribution Data Rule</a></p> </div> <h3>part d: CAQH CORE Claim Status Operating Rules </h3> <div> <p><i>Coming Soon</i></p> <p><a href="/faq-page/516" target="_blank">I. CAQH CORE 250: Claim Status Infrastructure Rule</a></p> </div> <h3>part e: CAQH CORE Payment &amp; Remittance Operating Rules </h3> <div> <p><a href="/faq-page/522" target="_blank">I. Overview of CAQH CORE Payment &amp; Remittance Operating Rules</a></p> <p><a href="/faq-page/523" target="_blank">II. Interdependent CAQH CORE Payment &amp; Remittance Requirements</a></p> <p><a href="/faq-page/524" target="_blank">III. CAQH CORE Payment &amp; Remittance (835) Infrastructure Rule</a></p> <p><a href="/faq-page/525" target="_blank">IV. CAQH CORE Payment &amp; Remittance Uniform Use of CARCs and RARCs (835) Rule</a></p> <p><a href="/faq-page/526" target="_blank">V. CAQH CORE Payment &amp; Remittance Reassociation (CCD+/835) Rule</a></p> <p><a href="/faq-page/527" target="_blank">VI. CAQH CORE Payment &amp; Remittance EFT Enrollment Data Rule</a></p> <p><a href="/faq-page/528" target="_blank">VII. CAQH CORE Payment &amp; Remittance ERA Enrollment Data Rule</a></p> <p><a href="/faq-page/529" target="_blank">VIII. Resources for Implementing the CAQH CORE Payment &amp; Remittance Operating Rules</a></p> </div> <h3>part f: Phase IV CAQH CORE Operating Rules</h3> <div> <p><a href="/faq-page/549" target="_blank">I. Overview of Phase IV CAQH CORE Operating Rules</a></p> <p><a href="/faq-page/550" target="_blank">II. CAQH CORE 450: Health Care Claim (837) Infrastructure Rule</a></p> <p><a href="/faq-page/551" target="_blank">III. CAQH CORE 452: Health Care Services Review - Request for Review and Response (278) Infrastructure Rule</a></p> <p><a href="/faq-page/552" target="_blank">IV. CAQH CORE 454: Benefit Enrollment and Maintenance (834) Infrastructure Rule</a></p> <p><a href="/faq-page/553" target="_blank">V. CAQH CORE 456: Premium Payment (820) Infrastructure Rule</a></p> <p><a href="/faq-page/554" target="_blank">VI. CAQH CORE 470: Connectivity Rule</a></p> <p><a href="/faq-page/555" target="_blank">VII. Resources for Implementing the Phase IV CAQH CORE Operating Rule</a></p> </div> <h3>part g: Phase V CAQH CORE Operating Rules</h3> <div> <p><a href="/faq-page/600" target="_blank">I. Overview of Phase V CAQH CORE Operating Rules</a></p> <p><a href="/faq-page/601" target="_blank">II. Phase V CAQH CORE Prior Authorization 278 Request / Response Data Content Rule</a></p> <p><a href="/faq-page/602" target="_blank">III. Phase V CAQH CORE Prior Authorization Web Portal Rule</a></p> </div> <h3>Part h: CAQH CORE Operating Rules in Development</h3> <div> <p><a href="/faq-page/530" target="_blank">I. Development of Remaining ACA-Mandated Operating Rules</a></p> <p><a href="/faq-page/531" target="_blank">II. Development of Voluntary Operating Rules</a></p> </div> <h3>Part i: Certification: ACA Section 1104 Certification, CORE Certification, Proposed CORE HIPAA Credential, and CORE Endorsement</h3> <div> <p><a href="/faq-page/532">I. Background on ACA Section 1104 Certification</a></p> <p>II. Introduction to CORE Certification</p> <ul class="no-bullet"><li>A. CORE Certification: Overview &amp; Policies <ul class="no-bullet"><li><a href="/faq-page/538" target="_blank">i. CORE Certification Overview</a></li> <li><a href="/faq-page/539" target="_blank">ii. CORE Certification Policies</a></li> </ul></li> <li>B. CORE Certification: Stakeholder Specific Questions <ul class="no-bullet"><li><a href="/faq-page/541" target="_blank">i. Questions Specific to Health Plans</a></li> <li><a href="/faq-page/542" target="_blank">ii. Questions Specific to Non-Health Plans</a></li> </ul></li> <li>C. CORE Certification: Testing <ul class="no-bullet"><li><a href="/faq-page/544" target="_blank">i. CORE Certification Testing Overview</a></li> <li><a href="/faq-page/545" target="_blank">ii. Eligibility &amp; Benefits CORE Certification Testing</a></li> <li><a href="/faq-page/546" target="_blank">iii. Claim Status CORE Certification Testing</a></li> <li><a href="/faq-page/547" target="_blank">iv. Payment &amp; Remittance CORE Certification Testing</a></li> <li><a href="/faq-page/561">v. Prior Authorization &amp; Referrals CORE Certification Testing</a></li> <li><a href="/faq-page/610">vi. Health Care Claims CORE Certification Testing</a></li> <li><a href="/faq-page/611">vii. Benefit Enrollment CORE Certification Testing</a></li> <li><a href="/faq-page/612">viii. Premium Payment CORE Certification Testing</a></li> </ul></li> </ul><p><a href="/faq-page/534">III. Introduction to Proposed CORE HIPAA Credential</a></p> <p><a href="/faq-page/535" target="_blank">IV. Introduction to CORE Endorsement</a></p> <p><a href="/faq-page/536">V. Related Resources and Links</a></p> </div> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/core" hreflang="en">CORE</a></div> </div> Tue, 12 Jan 2021 18:24:38 +0000 caqh_admin 1215 at https://www.caqh.org Resource Library https://www.caqh.org/core/resource-library <span>Resource Library</span> <span><span lang="" about="/users/mwoolstoncaqhorg" typeof="schema:Person" property="schema:name" datatype="">mwoolston@caqh.org</span></span> <span>Tue, 01/12/2021 - 13:21</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>CAQH CORE has produced a variety of online resources to provide education on operating rule implementation and CAQH CORE initiatives. </p> <h2>e-LEARNING RESOURCES</h2> <p>CAQH CORE has developed <a href="https://www.caqh.org/core/elearning-resources">interactive tools and dashboards</a> on topics of interest to industry stakeholders.</p> <h2>EDUCATION EVENTS</h2> <p>To increase industry awareness and adoption of healthcare operating rules, CAQH CORE offers interactive webinars in collaboration with leading healthcare organizations. These include quarterly Town Halls, webinar series on topics such as value-based payments and attachments, as well as sessions dedicated to operating rule implementation and maintenance, CORE Certification, and other topics of interest. In addition, CAQH CORE subject matter experts present at numerous national conferences.</p> <p><a href="/core/events">View all CAQH CORE events</a>.</p> <div class="accordion"> <h3>Webinar Series: Attachments</h3> <div> <ul><li><a href="https://www.youtube.com/watch?v=ClbkY7l3838&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=73&amp;t=0s">Delivering Value through Electronic Healthcare Attachments</a> (July 2019)</li> <li><a href="https://www.youtube.com/watch?v=HoVZIRcbaVk&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=58&amp;t=28s">Case Study on Vyne's Use of Electronic Dental Claim Attachments </a>(July 2018)</li> <li><a href="https://www.youtube.com/watch?v=HoVZIRcbaVk&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=58&amp;t=28s">Use &amp; Adoption of Attachments in Healthcare Administration</a> (January 2018)</li> <li><a href="https://www.youtube.com/watch?v=zoWP2lhKtak&amp;t=695s">Clinical Document Metadata</a> (November 2017)</li> <li><a href="https://www.youtube.com/watch?v=oHGwEFClsH0&amp;t=5s">Use and Adoption of Attachments in Healthcare Administration</a> (May 2017)</li> <li><a href="http://www.youtube.com/watch?v=L5oNn1gzm4Y&amp;token=ZVy5yjqU">CAQH CORE and eHealth Initiative Joint Webinar: Data Needs for Successful Value-based Care Outcomes</a> (March 2017)</li> </ul></div> <h3>Webinar Series: Value-based Payments</h3> <div> <ul><li><a href="https://youtu.be/kdJWHnN7J2c">Value-based Payment Initiative: Insights and Next Steps</a> (October 2019)</li> <li><a href="https://www.youtube.com/watch?v=Yq6qeBvWw6w&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=71&amp;t=1533s">State Medicaid Experience with VBP with Center for Health Care Strategies and Minnesota Medicaid </a>(June 2019)</li> <li><a href="https://www.youtube.com/watch?v=nTHS-AuZ33E&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=64&amp;t=0s">Attribution - Unlocking Value-based Purchasing's Full Potential, with the National Quality Forum</a> (January 2019)</li> <li><a href="https://www.youtube.com/watch?v=NKslCRYGm4Y&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=59&amp;t=2s">Quality Measures in VBP</a> (August 2018)</li> <li><a href="https://www.youtube.com/watch?v=ev0TTZR7Sic&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=56&amp;t=7s">The Role of Interoperability in VBP: ONC Perspective</a> (June 2018)</li> <li><a href="https://www.youtube.com/watch?v=VYw_j0QThcc&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=54&amp;t=9s">The Role of Interoperability in VBP: Dr. Kate Goodrich</a> (May 2018)</li> <li><a href="https://www.youtube.com/watch?v=Vl85LrIbEO0&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=53&amp;t=4s">All Together Now: Applying the Lessons of FFS to Streamline Adoption of VBP</a> (April 2018)</li> <li><a href="https://www.youtube.com/watch?v=As4rTPHLHn8&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=51&amp;t=8s">VBP: What Have We Learned and Where Are We Headed?</a> (March 2019)</li> <li><a href="https://www.youtube.com/watch?v=WprU_PwtGKE&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=50&amp;t=20s">CAQH CORE Participant Call on VBP Report</a> (February 2018)</li> <li><a href="https://www.youtube.com/watch?v=hm76GDE1abM&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=48&amp;t=17s">Implementing Successful VBP: Alternative Payment Models with CMMI</a> (January 2018)</li> <li><a href="https://www.youtube.com/watch?v=oQJJPO8hqhY&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=45&amp;t=367s">CAQH CORE and eHealthive Initiative Joint Webinar: Data Needs for Successful Value-based Care Outcomes</a> (November 2017)</li> </ul></div> </div> <h2>FAQs</h2> <p><span>CAQH CORE has developed <a href="https://www.caqh.org/core/frequently-asked-questions">Frequently Asked Questions (FAQs)</a> addressing CAQH CORE Operating Rules, general CAQH CORE information, CORE Certification and future development of operating rules.</span></p> <h2>INDUSTRY TOPICS AND COMMENT LETTERS</h2> <p>CAQH CORE shares activities for which it has submitted a <a href="https://www.caqh.org/core/industry-topics-and-comment-letters">comment letter</a>, held a public call, provided public testimony, etc.</p> <h2>OPERATING RULE IMPLEMENTATION RESOURCES</h2> <p>The <a href="https://www.caqh.org/core/industry-implementation-resources" target="_blank">Industry Implementation Resources</a> webpage has a number of free tools available to assist entities with both federal compliance and implementation of the CAQH CORE Operating Rules. CAQH CORE offers <a href="http://www.caqh.org/core/core-certification-process" target="_blank">CORE Certification</a> to entities that create, transmit or use administrative transactions in order for the entity to demonstrate its IT system or product is conformant with a specific transaction-based set of the CAQH CORE Operating Rules.</p> <div class="resources"> <h2>REPORTS AND WHITE PAPERS</h2> <p>CAQH CORE publishes <a href="https://www.caqh.org/core/reports-and-white-papers">reports and white papers</a> highlighting findings from research on key industry topics related to operating rules. The reports outline industry barriers and opportunities to drive industry automation and alignment of administrative and clinical processes.</p> </div> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-organization-type field--type-entity-reference field--label-inline"> <div class="field--label">Organization Type</div> <div class="field--item"><a href="/organization/health-plans" hreflang="en">Health plans</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/core" hreflang="en">CORE</a></div> </div> <div class="field field--name-field-taxonomy-status field--type-entity-reference field--label-inline"> <div class="field--label">Status</div> <div class="field--item"><a href="/status/review" hreflang="en">Review</a></div> </div> Tue, 12 Jan 2021 18:21:29 +0000 mwoolston@caqh.org 302 at https://www.caqh.org CAQH Contributes to Industry Study on Rising Healthcare Costs https://www.caqh.org/about/newsletter/2020/caqh-contributes-industry-study-rising-healthcare-costs <span>CAQH Contributes to Industry Study on Rising Healthcare Costs</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Thu, 10/08/2020 - 12:46</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">October 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span><span><span lang="EN" xml:lang="EN">The National Association of Insurance Commissioners (NAIC)’s Center for Insurance Policy and Research (CIPR) has released the final installment of its comprehensive study, “</span><span lang="EN" xml:lang="EN"><a href="https://content.naic.org/sites/default/files/inline-files/2020_CIPR_Rising%20Health%20Care%20Costs%203rd%20Installment.pdf"><span>Rising Health Care Costs: Drivers, Challenges and Solutions</span></a></span><span lang="EN" xml:lang="EN">.” A compilation of individually authored papers, this report brings together healthcare thought leaders, researchers and practitioners to provide a wide spectrum of viewpoints on the rising cost of care. </span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">CAQH contributed two papers to this report that examined cost savings opportunities through administrative workflows and alternative payment models. </span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">“Healthcare Administrative Workflow: Costs and Savings Opportunities” focuses on addressing administrative costs, highlighting saving opportunities to not only reduce healthcare spending, but also to ultimately direct more resources towards patient care. </span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">CAQH also authored “Adoption of Value-Based Payments Leveraging Fee-for-Service Lessons,” which describes how value-based care as an alternative to the traditional fee-for-service payment system provides a potential opportunity to improve individual care and population health while changing the trajectory of national health expenditures. </span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">The </span><span lang="EN" xml:lang="EN"><a href="http://naic.org"><span>NAIC</span></a></span><span lang="EN" xml:lang="EN"> is the nation’s standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. </span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">Read the full study </span><span lang="EN" xml:lang="EN"><a href="https://content.naic.org/sites/default/files/inline-files/2020_CIPR_Rising%20Health%20Care%20Costs%203rd%20Installment.pdf"><span>here</span></a></span><span lang="EN" xml:lang="EN">.</span></span></span></span></span></p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Thu, 08 Oct 2020 16:46:28 +0000 mnew@caqh.org 3086 at https://www.caqh.org CAQH and CAQH CORE to Lead Sessions at the WEDI National Conference https://www.caqh.org/about/newsletter/2020/caqh-and-caqh-core-lead-sessions-wedi-national-conference <span>CAQH and CAQH CORE to Lead Sessions at the WEDI National Conference</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Thu, 10/08/2020 - 12:43</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">October 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span><span><span lang="EN" xml:lang="EN">WEDI has announced that CAQH and CAQH CORE will be leading two sessions at the organization’s upcoming National Conference:</span></span></span></span></span></p> <p><span><span><span><span><b><span lang="EN" xml:lang="EN">The CAQH CORE Attachments Update (10/16 from 12:45-1:30 ET).</span></b><span lang="EN" xml:lang="EN"> During this interactive session, Robert Bowman, Director, CORE, will provide an update on CAQH CORE operating rule development related to attachments and the electronic exchange of additional medical documentation to support prior authorization and claims. To learn more about CAQH CORE Attachment Initiatives, </span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/core/additional-medical-documentationattachments"><span>click here</span></a></span><span lang="EN" xml:lang="EN">.</span></span></span></span></span></p> <p><span><span><span><span><b><span lang="EN" xml:lang="EN">CAQH Endpoint Directory Overview &amp; Demo (10/21 from 3:00-3:45 ET).</span></b><span lang="EN" xml:lang="EN"> CAQH will provide an overview of the new centralized directory of validated FHIR endpoints and third-party applications, which simplifies how organizations and app developers connect to help consumers access their health information. CAQH is developing this industry utility, which launches early 2021, with support from Edifecs. During this session, CAQH will share how the solution will help payers meet the new CMS regulations, and will also provide a demo with Humana. To learn more about the CAQH Endpoint Directory, </span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/solutions/caqh-endpoint-directory"><span>click here</span></a></span><span lang="EN" xml:lang="EN">.</span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">The </span><span lang="EN" xml:lang="EN"><a href="https://members.wedi.org/event-calendar/Details/wedi-national-conference-160878?sourceTypeId=Website"><span>WEDI National Conference</span></a></span><span lang="EN" xml:lang="EN"> provides a look at health IT emerging technology, consumer data exchange trends and best practices and policy updates. Attended by stakeholders from across healthcare, this year’s agenda will focus on regulations, standards and health IT innovation. </span></span></span></span></span></p> <p><span><span><span><span lang="EN" xml:lang="EN">To register for the WEDI National Conference, click </span><a href="https://members.wedi.org/event-calendar/Details/wedi-national-conference-160878?sourceTypeId=Website"><span>here</span></a><span lang="EN" xml:lang="EN">. </span></span></span></span></p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Thu, 08 Oct 2020 16:43:32 +0000 mnew@caqh.org 3085 at https://www.caqh.org CAQH CORE Shares Initial Findings of Prior Authorization Pilot & Measurement Initiative https://www.caqh.org/about/newsletter/2020/caqh-core-shares-initial-findings-prior-authorization-pilot-measurement-0 <span>CAQH CORE Shares Initial Findings of Prior Authorization Pilot &amp; Measurement Initiative</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Thu, 10/08/2020 - 12:39</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">October 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span><span><span lang="EN" xml:lang="EN">In August, CAQH CORE hosted a webinar to share initial findings of the Prior Authorization Pilot &amp; Measurement Initiative, which works with industry organizations to measure the impact of standards and operating rules on efficiency metrics and staff experience. The case study webinar with Cleveland Clinic and PriorAuthNow, the first in a series, highlighted the impact that prior authorization (PA) automation and workflow integration may have on the health system. </span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">Attendees learned how the implementation of a PA solution leveraging the standard transaction and CAQH CORE PA operating rules is improving the ability of the health system’s staff to conduct PAs, creating a more efficient process and alleviating administrative burdens.</span> <span lang="EN" xml:lang="EN">For example, initial results show an 80% reduction in staff time—savings of at least 12 minutes—spent on prior authorization compared to web portals.</span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">To view the webinar recording,</span><span lang="EN" xml:lang="EN"> <a href="https://www.youtube.com/watch?v=gJCxjfKbdLk&amp;t=130s"><span>click here</span></a></span><span lang="EN" xml:lang="EN">.</span></span></span></span></span></p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Thu, 08 Oct 2020 16:39:09 +0000 mnew@caqh.org 3084 at https://www.caqh.org CAQH Releases Annual Report https://www.caqh.org/about/newsletter/2020/caqh-releases-annual-report <span>CAQH Releases Annual Report</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Thu, 10/08/2020 - 12:36</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">October 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span lang="EN" xml:lang="EN"><span><span><span>To mark the 20th anniversary of CAQH, this year’s annual report tells the story of the organization’s founding, provides highlights from initiatives over the years, and outlines its vision to transform the business of healthcare in the future.</span></span></span></span></p> <p><a href="https://www.caqh.org/sites/default/files/2019-CAQH-annual-report.pdf">Click here</a> to read the 2019 CAQH annual report.</p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Thu, 08 Oct 2020 16:36:29 +0000 mnew@caqh.org 3083 at https://www.caqh.org CAQH CORE Presents Prior Authorization Operating Rules for Federal Adoption https://www.caqh.org/about/newsletter/2020/caqh-core-presents-prior-authorization-operating-rules-federal-adoption <span>CAQH CORE Presents Prior Authorization Operating Rules for Federal Adoption</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Fri, 08/28/2020 - 10:59</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">August 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span><span><span lang="EN" xml:lang="EN">Health insurers use prior authorization as a check on the safety, quality, necessity and cost of medical services. When done manually, this process can be confusing, labor-intensive and expensive for the provider and payer teams that manage it. This can create delays to patient care, and frustrations across the industry. </span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">This month, CAQH CORE</span><span lang="EN" xml:lang="EN"> <a href="https://www.caqh.org/sites/default/files/core/CAQH%20CORE%20NCVHS%20Review%20Request%202.24.20_FINAL_1.pdf?token=4GGVq35S"><span>proposed</span></a></span><span lang="EN" xml:lang="EN"> three Prior Authorization &amp; Connectivity Operating Rules to accelerate automation of the prior authorization process at a hearing with the</span><span lang="EN" xml:lang="EN"><a href="https://ncvhs.hhs.gov/"> </a><a href="https://ncvhs.hhs.gov/"><span>National Committee on Vital and Health Statistics</span></a></span><span lang="EN" xml:lang="EN"> (NCVHS), an advisory committee to the Secretary of the Department of Health and Human Services.</span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">The proposed rules standardize components of the prior authorization process by closing gaps in electronic data exchange to enable a more automated adjudication of a request. The rules also establish two-day maximum response times for health plans to respond to a provider regarding needed documentation and to provide a final determination once all documentation is received. Additionally, the CAQH CORE Connectivity Rule vC3.1.0 establishes a safe harbor connectivity method that drives industry alignment by converging on common transport, message envelope, security and authentication standards.</span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">However, there is still work to be done. If you would like to voice your support for the proposed operating rules, please: </span></span></span></span></span></p> <ul><li><span><span><span><span><span lang="EN" xml:lang="EN">Post on your social media channels and tag @CAQH</span></span></span></span></span></li> <li><span><span><span><span><span lang="EN" xml:lang="EN">Share content from the CAQH</span><span lang="EN" xml:lang="EN"><a href="https://www.linkedin.com/company/caqh"> </a><a href="https://www.linkedin.com/company/caqh"><span>LinkedIn</span></a></span><span lang="EN" xml:lang="EN"> and</span><span lang="EN" xml:lang="EN"><a href="http://twitter.com/caqh"> </a><a href="http://twitter.com/caqh"><span>Twitter</span></a></span><span lang="EN" xml:lang="EN"> pages</span></span></span></span></span></li> <li><span><span><span><span><span lang="EN" xml:lang="EN">Contact </span><span lang="EN" xml:lang="EN"><a href="mailto:caqhcore@caqh.org">caqhcore@caqh.org</a></span></span></span></span></span></li> </ul><p><span><span><span><span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/sites/default/files/core/NCVHS_Rule_Package_Contents.pdf?token=rALnfU8M"><span>Click here</span></a></span><span lang="EN" xml:lang="EN"> to learn more about the operating rules and how to get engaged in future rule development.</span></span></span></span></span></p> <p>Read more about the importance of streamlining prior authorizations in <a href="https://www.modernhealthcare.com/opinion-editorial/fully-automate-prior-authorization-cut-waste-relieve-administrative-burden">Modern Healthcare</a>.</p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Fri, 28 Aug 2020 14:59:01 +0000 mnew@caqh.org 3069 at https://www.caqh.org CAQH Achieves HITRUST CSF Certification for Third Consecutive Year https://www.caqh.org/about/newsletter/2020/caqh-achieves-hitrust-csf-certification-third-consecutive-year <span>CAQH Achieves HITRUST CSF Certification for Third Consecutive Year</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Fri, 08/28/2020 - 10:52</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">August 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span><span><span lang="EN" xml:lang="EN">CAQH has earned certifications for information security by the Health Information Trust (HITRUST) Alliance for</span> <span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/solutions/caqh-proview"><span><span><span>CAQH ProView</span></span></span></a></span><span lang="EN" xml:lang="EN"><sup>®</sup>, </span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/solutions/cob-smart"><span><span><span>COB Smart</span></span></span></a></span><span lang="EN" xml:lang="EN"><sup>®</sup>, </span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/solutions/enrollhub"><span><span><span>EnrollHub</span></span></span></a></span><span lang="EN" xml:lang="EN"><sup>®</sup>, </span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/solutions/directassure"><span><span><span>DirectAssure</span></span></span></a></span><span lang="EN" xml:lang="EN"><sup>®</sup>, </span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/solutions/verifide"><span><span><span>VeriFide</span></span></span></a></span><span lang="EN" xml:lang="EN">™ and </span><span lang="EN" xml:lang="EN"><a href="https://www.caqh.org/solutions/sanctionstrack"><span><span><span>SanctionsTrack</span></span></span></a></span><span lang="EN" xml:lang="EN"><sup>®</sup>. </span><span lang="EN" xml:lang="EN">With the HITRUST CSF Certified Status, these products have been proven to meet important regulations and requirements for protecting and securing sensitive private healthcare information.</span></span></span></span></span></p> <p><span><span><span><span><span><span lang="EN" xml:lang="EN">This achievement places CAQH in an elite group of organizations worldwide that have earned this certification. The HITRUST CSF is a thorough evaluation that includes federal and state regulations, standards and frameworks and incorporates a risk-based approach. It also addresses these challenges through a comprehensive and flexible framework of prescriptive and scalable security controls.</span></span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">As CAQH follows security best practices, the organization and its Solutions will continuously maintain HITRUST Certification status.</span></span></span></span></span></p> <p><span><span><span><span><span lang="EN" xml:lang="EN">To learn more about the CAQH Solutions, <a href="https://www.caqh.org/solutions"><span>click here</span></a></span><span lang="EN" xml:lang="EN">. </span></span></span></span></span></p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Fri, 28 Aug 2020 14:52:56 +0000 mnew@caqh.org 3068 at https://www.caqh.org