Health plans https://www.caqh.org/ en Maintaining High Quality Credentialing Amid The Great Resignation https://www.caqh.org/solutions/maintaining-high-quality-credentialing-amid-great-resignation <span>Maintaining High Quality Credentialing Amid The Great Resignation</span> <span><span lang="" about="/users/lwadecaqhorg" typeof="schema:Person" property="schema:name" datatype="">lwade@caqh.org</span></span> <span>Fri, 05/06/2022 - 13:48</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span><span lang="EN" xml:lang="EN"><span>As a result of COVID-19, and the strain the pandemic has put on healthcare providers, unprecedented numbers of clinicians are leaving their practices–or healthcare altogether.</span></span></span></span></span></p> <p><span><span><span><span lang="EN" xml:lang="EN"><span>For health plans, this high level of turnover could have significant consequences for the size and quality of their provider network–as well as their ability to maintain an accurate provider directory.</span></span></span></span></span></p> <h3><span><span><span><b><span lang="EN" xml:lang="EN"><span>WIDESPREAD  PHYSICIAN TURNOVER</span></span></b></span></span></span></h3> <p><span><span><span><span lang="EN" xml:lang="EN"><span>In </span></span><span><a href="https://go.caqh.org/l/339361/2022-05-06/4dllsv"><span>a recent survey</span></a><span>, physicians expressed concern about increased paperwork and administrative burdens interfering with their ability to treat patients or spend time away from work. Unfortunately, this is not a new issue. And while the industry is making progress in this arena–for example, by </span><a href="https://go.caqh.org/l/339361/2022-05-06/4dlnzr"><span>adopting more electronic processes</span></a><span> to manage common administrative transactions–there is still much work to be done. </span></span></span></span></span></p> <p><span><span><span><span lang="EN" xml:lang="EN"><span>In the last two years, the time and financial constraints brought on by inefficient administrative processes have been further compounded by unprecedented patient loads during COVID-19. This has required many physicians to work long, and unpredictable hours while managing their regular responsibilities.</span></span></span></span></span></p> <p><span><span><span><span lang="EN" xml:lang="EN"><span>As a result of these factors, in the last year, </span></span><span><a href="https://go.caqh.org/l/339361/2022-05-06/4dllsv"><span>46% of physicians</span></a><span> considered leaving their current workplace to look for a new healthcare employer, and 43% considered early retirement. </span></span></span></span></span></p> <p><span><span><span><span lang="EN" xml:lang="EN"><span>For health plans, maintaining their network could require fast, wide-scale recruitment and onboarding of new providers. However, this cannot come at the expense of accurate credentialing and regulatory considerations, appropriate allocation of financial resources, or member satisfaction.</span></span></span></span></span></p> <h3><span><span><span><b><span lang="EN" xml:lang="EN"><span>A STREAMLINED SOLUTION</span></span></b></span></span></span></h3> <p><span><span><span><span lang="EN" xml:lang="EN"><span>Developed in partnership with member health plans, VeriFide<sup>TM</sup> from CAQH consolidates and standardizes the primary source verification (PSV) process.</span></span></span></span></span></p> <p><span><span><span><span lang="EN" xml:lang="EN"><span>Seamlessly integrated with CAQH ProView, VeriFide leverages self reported data from 1.9 million providers who regularly attest to their professional and practice information. It also affords health plans greater accuracy, speed and control over their PSV processes through: </span></span></span></span></span></p> <ul><li><span><span><span><span><b><span lang="EN" xml:lang="EN"><span>Automation with most primary data sources. </span></span></b><span lang="EN" xml:lang="EN"><span>VeriFide deploys advanced automated technologies that compare each provider’s information against primary data sources for accuracy. By eliminating manual processes, it takes less time to work on a provider file, and also reduces the likelihood of human error. </span></span></span></span></span></span><br />  </li> <li><span><span><span><span><b><span lang="EN" xml:lang="EN"><span>Standardization of data elements for quicker credentialing. </span></span></b><span lang="EN" xml:lang="EN"><span>Each health plan participating in VeriFide agrees to limit the verified data elements to the standard set of 14 required by NCQA. This is the information deemed essential for the credentialing process.</span></span></span></span></span></span><br />  </li> <li><span><span><span><span><b><span lang="EN" xml:lang="EN"><span>Industry-wide alignment of provider credentialing dates. </span></span></b><span lang="EN" xml:lang="EN"><span>NCQA requires health plans to re-credential providers at least once every three years. This process is conducted in different months by different plans, creating duplication for providers contracting with multiple health plans. To reduce this inefficiency and duplication process, over time VeriFide will align credentialing dates for providers, so that each will have a dedicated re-credentialing date across all health plans.</span></span></span></span></span></span><br />  </li> <li><span><span><span><span><b><span lang="EN" xml:lang="EN"><span>Categorized results for quicker credentialing. </span></span></b><span lang="EN" xml:lang="EN"><span>Each verified data element in the provider file is categorized by VeriFide, based on the results of the verification; for example, A is valid and current, B is potentially irregular and C is very irregular. This enables each health plan to immediately and automatically route the files needing special follow-up to their appropriate departments, reducing delays.</span></span></span></span></span></span></li> </ul><p><span><span><span><span lang="EN" xml:lang="EN"><span>And </span></span><span lang="EN" xml:lang="EN"><span>VeriFide returns 95% of initial provider files within 8 -14 days, with 98.5% accuracy and completeness–saving critical time when managing a high volume of providers.  </span></span></span></span></span></p> <p><span><span><span><span lang="EN" xml:lang="EN"><span>To learn how VeriFide can help your organization improve its PSV process, contact <a href="psv@caqh.org">PSV@CAQH.org</a>.  </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-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/verifide" hreflang="en">VeriFide</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/final" hreflang="en">Final</a></div> </div> Fri, 06 May 2022 17:48:54 +0000 lwade@caqh.org 3839 at https://www.caqh.org Improving Health Plan Provider Directories https://www.caqh.org/about/event/improving-health-plan-provider-directories <span>Improving Health Plan Provider Directories</span> <span><span lang="" about="/users/lwadecaqhorg" typeof="schema:Person" property="schema:name" datatype="">lwade@caqh.org</span></span> <span>Tue, 04/05/2022 - 13:47</span> <div class="field field--name-field-event-type field--type-list-string field--label-hidden field--item">Webinar</div> <div class="field field--name-field-start-date field--type-daterange field--label-hidden field--item"><time datetime="2022-04-05T18:17:00Z">April 05, 2022 | 02:17 PM EDT</time> - <time datetime="2022-04-06T18:17:00Z">April 06, 2022 | 02:17 PM EDT</time> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>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.</p> <p>Industry leaders Sorin Davis of CAQH and Tammy Weaver of the American Medical Association discuss how providers and health plans can work together to improve the accuracy of plan directories.</p> <p><strong>Presentation Resources:</strong></p> <ul><li><a href="https://go.caqh.org/l/339361/2022-04-12/49p1fz">Webinar Questions and Answers</a></li> <li><a href="https://go.caqh.org/l/339361/2022-04-05/49639l">PowerPoint Presentation</a></li> <li><a href="https://go.caqh.org/l/339361/2022-04-05/49639d">On Demand Webinar</a></li> <li><a href="//efaidnbmnnnibpcajpcglclefindmkaj/viewer.html?pdfurl=https%3A%2F%2Fwww.caqh.org%2Fsites%2Fdefault%2Ffiles%2Fother%2FCAQH-AMA_Improving%2520Health%2520Plan%2520Provider%2520Directories%2520Whitepaper.pdf&amp;clen=165084&amp;chunk=true">White Paper:  Improving Health Plan Provider Directories</a></li> </ul></div> <span class="a2a_kit a2a_kit_size_36 addtoany_list" data-a2a-url="https://www.caqh.org/about/event/improving-health-plan-provider-directories" data-a2a-title="Improving Health Plan Provider Directories"><a class="a2a_button_twitter"></a><a class="a2a_button_linkedin"></a><a class="a2a_button_facebook"></a></span> <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/directassure" hreflang="en">DirectAssure</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> Tue, 05 Apr 2022 17:47:20 +0000 lwade@caqh.org 3550 at https://www.caqh.org Request Product Demo https://www.caqh.org/solutions/request-product-demo <span>Request Product Demo</span> <span><span lang="" about="/users/afinchcaqhorg" typeof="schema:Person" property="schema:name" datatype="">afinch@caqh.org</span></span> <span>Thu, 02/04/2021 - 12:11</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><iframe allowtransparency="true" frameborder="0" height="800" src="//go.caqh.org/l/339361/2021-02-04/2lwg8x" type="text/html" width="100%"></iframe></p> </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/caqh-large" hreflang="en">CAQH at Large</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/final" hreflang="en">Final</a></div> </div> Thu, 04 Feb 2021 17:11:12 +0000 afinch@caqh.org 3163 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>Advanced EOB Advisory Group</span></strong></td> <td><span>Guidance Development</span></td> <td> <p class="paragraph"><span><span><span><span><span>Guide CAQH CORE's work on industry implementation of price transparency regulations, with special focus on the <b>A<strong>dvanced EOB requirements in the No Surprises Act</strong></b>.</span></span></span></span></span></p> <p class="paragraph"><span><span><span><span><span>Convene a series of focus groups throughout 2022 to gain insights, identify barriers, understand industry progress, and consider opportunities to support implementation of price transparency requirements. Each focus group will be followed with an industry webinar.</span></span></span></span></span></p> </td> <td> <p>N/A</p> </td> <td> <p>Every 3 Months</p> </td> </tr><tr><td><strong>Review Work Group (RWG)</strong></td> <td>Rule Development</td> <td>Further reviewing and refining draft rules including both Draft Attachments Operating Rule Sets to ensure uniformity and cohesion across use cases, the Draft Eligibility and Benefits Data Content Rule Update, and Infrastructure Rule Updates. </td> <td> <p><strong>Donna Campbell</strong> HCSC</p> <p><strong>Mehesh Siddanati</strong> Centene</p> <p><strong>Molly Reese</strong> AMA</p> </td> <td>Rules approved in February 2022.</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>Lynn Franco</strong>  UnitedHealth Group </p> <p><strong>Heather Morgan</strong>  Aetna</p> <p><strong>Molly Reese</strong> AMA</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 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 Prior Authorization Automation Case Study Webinar with Cleveland Clinic, PriorAuthNow and CAQH CORE https://www.caqh.org/about/event/prior-authorization-automation-case-study-webinar-cleveland-clinic-priorauthnow-and <span>Prior Authorization Automation Case Study Webinar with Cleveland Clinic, PriorAuthNow and CAQH CORE</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 08/05/2020 - 12:54</span> <div class="field field--name-field-event-type field--type-list-string field--label-hidden field--item">Webinar</div> <div class="field field--name-field-start-date field--type-daterange field--label-hidden field--item"><time datetime="2020-08-17T18:00:00Z">August 17, 2020 | 02:00 PM EDT</time> - <time datetime="2020-08-17T19:00:00Z">August 17, 2020 | 03:00 PM EDT</time> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>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.<br /><br /> This is the first case study webinar in a series related to the CAQH CORE 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.<br /><br /><strong>What will you learn by registering for this webinar?</strong></p> <ul><li>Learn more about Cleveland Clinic’s prior authorization experience, implementation of the PriorAuthNow solution, and its commitment to prior authorization standardization.</li> <li>Hear about the impact that enhanced automation leveraging standards and operating rules has on provider staff administrative burden and satisfaction, as well as other metrics.</li> <li>Discuss how the operating rules and associated standards enable a more optimized prior authorization process and can seamlessly integrate into the provider workflow.</li> </ul><p><strong>Speakers:</strong></p> <ul><li><strong>Daniel Medve</strong>, Director, Revenue Cycle Management, Cleveland Clinic</li> <li><strong>Dan Dedels</strong>, Senior Vice President, Customer Operations, PriorAuthNow</li> <li><strong>Bob Bowman</strong>, Director, CAQH CORE</li> <li><strong>Kristine Burnaska</strong>, Director, CAQH Explorations</li> <li><strong>Rachel Goldstein,</strong> Senior Manager, CAQH CORE</li> </ul></div> <span class="a2a_kit a2a_kit_size_36 addtoany_list" data-a2a-url="https://www.caqh.org/about/event/prior-authorization-automation-case-study-webinar-cleveland-clinic-priorauthnow-and" data-a2a-title="Prior Authorization Automation Case Study Webinar with Cleveland Clinic, PriorAuthNow and CAQH CORE"><a class="a2a_button_twitter"></a><a class="a2a_button_linkedin"></a><a class="a2a_button_facebook"></a></span> <div class="field field--name-field-resource-list-title field--type-string field--label-hidden field--item">Webinar Resources</div> <div class="field field--name-field-resource-list field--type-file field--label-hidden field--items"> <div class="field--item"><span class="file file--mime-application-pdf file--application-pdf icon-before"><span class="file-icon"><span class="icon glyphicon glyphicon-file text-primary" aria-hidden="true"></span></span><span class="file-link"><a href="https://www.caqh.org/sites/default/files/core/CORE_Cleveland_Clinic_PriorAuthNow_Case_Study_Webinar_Slides.pdf" type="application/pdf; length=1855165" title="Open file in new window" target="_blank" data-toggle="tooltip" data-placement="bottom">CORE Cleveland Clinic PriorAuthNow Case Study Webinar Slides</a></span><span class="file-size">1.77 MB</span></span></div> <div class="field--item"><a href="https://www.youtube.com/watch?v=gJCxjfKbdLk&amp;list=PLGulir3D2LZSjqI2vTFMyPb_SnN4Z2sJA&amp;index=2&amp;t=0s" target="_blank" class="field-resource-list-remote-video last" hreflang="en">Prior Authorization Automation Case Study Webinar with Cleveland Clinic and PriorAuthNow</a></div> </div> <div class="field field--name-field-resource-list-remote-video field--type-entity-reference field--label-hidden field--items"> <div class="field--item"><a href="/media/232/edit" hreflang="en">Prior Authorization Automation Case Study Webinar with Cleveland Clinic and PriorAuthNow</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-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> Wed, 05 Aug 2020 16:54:52 +0000 mnew@caqh.org 3059 at https://www.caqh.org How It All Began https://www.caqh.org/about/newsletter/2020/how-it-all-began <span>How It All Began</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 07/29/2020 - 16:01</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">July 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>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.</p> <p>While today CAQH is focused on streamlining business challenges, some of the early initiatives addressed clinical issues. Here are a few examples:</p> <p><em>Health Outcomes.</em></p> <p>CAQH members leveraged their collective reach to support providers in educating patients on appropriate usage of critical drug therapies. Two areas were targeted for awareness campaigns – appropriate antibiotic usage and long-term adherence to beta blockers after a heart attack. Both campaigns worked closely with key clinical partners, including the CDC, for antibiotic use, and the American Heart Association, American College of Cardiology, American Academy of Family Physicians and American College of Physicians for beta blocker adherence. CAQH also partnered with NCQA to develop new standardized HEDIS measures to track antibiotic and beta blocker prescribing. Data was collected across states using the CAQH-developed measures to determine if improvements were being achieved.</p> <p><em>Access to Care. </em></p> <p>When CAQH was formed, HMOs, point-of-service plans and other gatekeeper products were emerging as a cost management strategy. These offerings provided consumers with options, but they also created confusion about how to access specialty and emergency care. To address this, CAQH member health plans committed to allow direct access to Ob-Gyn care, provide coverage for emergency visits that a reasonable person would consider an emergency and require binding independent review of medical necessity decisions. These commitments have become foundational in health coverage today.</p> <p><em>Formulary Transparency. </em></p> <p>As health plans adopted formularies to manage rising costs for prescription medicines, providers often struggled to determine which drugs were included in each plan’s formulary. This resulted in high levels of rework if a drug was not covered once the patient arrived at the pharmacy. CAQH addressed this challenge by creating a first-of-its-kind, real-time industry database that allowed providers to search during the patient visit and quickly understand the formulary status by health plan. As nascent e-prescribing applications gained a foothold, CAQH partnered with RxHub (now SureScripts) to expand and imbed its formulary database in the e-prescribing workflow. This partnership resulted in a single source of formulary data for the majority of commercially insured Americans.</p> <p><em>Credentialing Applications. </em> </p> <p>Each health plan required its network providers to submit detailed information about their practices, demographics, licensure and training upon application to the network and every three years thereafter. For a provider under contract with 10 or more health plans, each with its own way of collecting the information, this was a significant administrative burden. To address this challenge CAQH worked across health plans, providers, and other stakeholders to build and adopt a common industry provider data collection platform, now known as <a href="https://www.caqh.org/solutions/caqh-proview">CAQH ProView</a>. The platform standardized, centralized and automated paper credentialing forms so that providers completed the process once instead of multiple times for the various health plans with which they worked. In launching this service, CAQH set the foundation for developing trust with providers as they realized the cost-saving benefits of the centralized platform while maintaining control of their data.</p> <p>By the end of 2004, CAQH had eliminated over 400,000 paper credentialing applications and saved hundreds of thousands of hours of provider staff time.</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/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Wed, 29 Jul 2020 20:01:55 +0000 mnew@caqh.org 3056 at https://www.caqh.org An Interview with Sorin Davis, Senior Vice President, Industry Relations https://www.caqh.org/about/newsletter/2020/interview-sorin-davis-senior-vice-president-industry-relations <span>An Interview with Sorin Davis, Senior Vice President, Industry Relations</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 07/29/2020 - 15:58</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">July 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><strong>What was the original inspiration for CAQH, and what was going on in healthcare that prompted the health plans to create the organization?</strong></p> <p>In 2000, the healthcare industry was experiencing significant abrasion between providers and payers. In particular, providers were communicating to patients how difficult it was to work with insurers. As a result, consumer sentiment regarding health insurers was at a low point. At the same time, health insurers were fierce competitors and appeared unable to collaborate. Because of those perceptions, two forward thinking CEOs, Len Schaeffer from then WellPoint (now Anthem) and Jay Gellert from HealthNet, decided that payers needed to find a way to work together to address common problems. Many other CEOs agreed, and the idea of CAQH was born.</p> <p><strong>In what ways has CAQH evolved over the past 20 years, and in what ways has it stayed the same?</strong></p> <p>Over the past 20 years, CAQH has become a recognized industry thought leader that can not only convene and align stakeholders on industry administrative simplification issues, but also has the ability to deploy technology solutions to address them. Additionally. CAQH CORE has become the industry authority on operating rules and automating business transactions. In fact, certain operating rules developed by the industry for the industry through CAQH CORE have been made requirements by the federal government.</p> <p>Here is what hasn’t changed: our mission and commitment to improve the healthcare system through a transparent process in which diverse stakeholders come together to solve common problems.</p> <p><strong>If you could pick one CAQH initiative that has the greatest impact on healthcare, what would that be?</strong></p> <p>CAQH ProView. This solution is widely used by both providers and payers and it is what CAQH is best known for. And we are proud of the difference it has made for the industry.</p> <p><strong>The marketplace is changing rapidly today. What do you see as the greatest contribution CAQH can make to healthcare going forward?</strong></p> <p>Our greatest contribution going forward will likely be our proven ability to bring disparate stakeholders together and reach alignment on administrative simplification issues impacting providers and payers. We have been successful at this and will continue to be, in part, because of the trust we have earned from providers, health plans and vendors over the past 20 years. Here’s a perfect example: COB Smart is transforming the way coordination of benefits is conducted because health plans have enough confidence in us that they are willing to provide continuous access to their membership rosters.</p> <p>This is just one example, but our reputation for integrity, transparency, collaboration and mission have put us in a unique position to convene industry stakeholders and solve common administrative problems—of which there are many.</p> <p><strong>As the SVP of Industry Relations, what initiatives are you currently working on that you are particularly excited about</strong>?</p> <p>I’m particularly excited about two initiatives; first demonstrating that an entire market, Massachusetts, is adopting DirectAssure as the state standard for provider data collection, maintenance and distribution. This statewide endorsement is a model we are hopeful to see in other states and nationally, as well. </p> <p>We are also working on another very exciting initiative; CAQH is developing a relationship with the American Medical Association to collaborate on potential administrative simplification initiatives. I believe partnering with provider stakeholders is an important step in our growth.</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/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Wed, 29 Jul 2020 19:58:46 +0000 mnew@caqh.org 3055 at https://www.caqh.org CAQH Recognized as Best Place to Work Five Years in a Row https://www.caqh.org/about/newsletter/2020/caqh-recognized-best-place-work-five-years-row <span>CAQH Recognized as Best Place to Work Five Years in a Row</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 07/29/2020 - 15:49</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">July 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>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.</p> <p>“As we celebrate the 20th anniversary of CAQH, we know that we would not have been able to achieve as much without a team of innovative, mission-driven professionals dedicated to addressing healthcare’s biggest business challenges,” said Robin Thomashauer, President of CAQH. “While it is an honor to receive this recognition from Modern Healthcare, it is an even greater honor to work every day with such an inspiring team.”</p> <p>The Modern Healthcare “Best Places to Work in Healthcare” honors organizations throughout the industry that empower employees to provide patients and customers with the best possible care, products and services.</p> <p>This year, the judges also took into consideration how the employers were able to adapt and accommodate their staff amid the COVID-19 pandemic. Since stay-at-home orders were implemented earlier this year, the CAQH team has worked virtually, and continued innovating and delivering the high levels of customer service that participating organizations and providers have come to expect.</p> <p>Congratulations to the entire CAQH team for your ongoing dedication to the organization’s mission, and each other. </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/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Wed, 29 Jul 2020 19:49:34 +0000 mnew@caqh.org 3053 at https://www.caqh.org SSI Group, Availity Achieve Additional CAQH CORE Certifications https://www.caqh.org/about/newsletter/2020/ssi-group-availity-achieve-additional-caqh-core-certifications <span>SSI Group, Availity Achieve Additional CAQH CORE Certifications</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 06/24/2020 - 10:45</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">June 2020</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><a href="https://thessigroup.com/">SSI Group</a> and <a href="https://www.availity.com/">Availity</a>, 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 &amp; Referrals (infrastructure). Availity also achieved certification for Health Care Claims. Previously, both SSI and Availity were CAQH CORE-certified for Eligibility &amp; Benefits, Claim Status and Payment &amp; Remittance.</p> <p>CAQH CORE Certification is a voluntary program that recognizes entities that create, transmit or use the healthcare administrative and financial transactions following the CAQH CORE Operating Rules.</p> <p>To learn more about CAQH CORE Certification, contact <a href="mailto:core@caqh.org?subject=CAQH%20CORE%20Certification%20">core@caqh.org</a> or <a href="https://www.caqh.org/core/core-certification">click here</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/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Wed, 24 Jun 2020 14:45:27 +0000 mnew@caqh.org 3047 at https://www.caqh.org