Health plans https://www.caqh.org/ en Your provider directory may advertise claims payment addresses for practice locations https://www.caqh.org/solutions/your-provider-directory-may-advertise-claims-payment-addresses-practice-locations <span>Your provider directory may advertise claims payment addresses for practice locations</span> <span><span lang="" about="/users/lwadecaqhorg" typeof="schema:Person" property="schema:name" datatype="">lwade@caqh.org</span></span> <span>Tue, 08/30/2022 - 00:11</span> <div class="field field--name-field-subtitle field--type-text-long field--label-hidden field--item"><h2><p>How can you be certain you are collecting the correct information?</p></h2></div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><i>Collecting and confirming provider data is a time-consuming and costly venture.</i></p> <p>Providers are inundated with requests from payers for updated practice information while attempting to balance treating patients and juggling other administrative concerns. For some providers it all comes down to ensuring they are reimbursed in a timely fashion, this is why they will often default to using their claims reimbursement address in every ask for contact or practice information.</p> <p>The directory data management services at CAQH simplifies the practice data collection process by enabling practitioners to update their directory information once and share it with all participating health plans authorized to receive the data.</p> <p>Providers are presented with directory-related questions. Users are also shown previously captured practice location data to update, confirm or discard. This reduces the likelihood of receiving a claims reimbursement address if it is not also used for seeing patients.</p> <br> <p><img alt="Figure 1: Previously captured practice locations for confirmation" data-align="center" data-caption="Figure 1: Previously captured practice locations for confirmation" data-entity-type="" data-entity-uuid="" src="/sites/default/files/dapraclocs1.png" style="box-shadow: 5px 1px 5px 3px lightgray; margin:auto; display:block; width:75%;"/></p> <p style="text-align:center;"><i>Figure 1: Previously captured practice locations for confirmation</i></p> <h1></h1> <br> <p>This multilayered, bi-directional data validation approach ensures high data accuracy and quality, while reducing the likelihood of receiving a claims reimbursement address if it is not also used for seeing patients.</p> <p>To assist healthcare organizations in meeting The Consolidated Appropriations/No Surprises Act, 2021, the solution circulates emails to providers every 90-days encouraging them to update, submit and confirm their practice information. The date in which the provider practice location was last updated and confirmed is captured and catalogued for health plans and providers in case proof of outreach and updates are needed.</p> <h1></h1> <p><img alt="Figure 2: Active Practice Location Details" data-align="center" data-entity-type="" data-entity-uuid="" src="/sites/default/files/dapraclocs2.png" style="box-shadow: 5px 1px 5px 3px lightgray; margin:auto; display:block; width:75%;"/></p> <p style="text-align:center;"><i>Figure 2: Active Practice Location Details</i></p> <br> <p>For more information on how the directory data management services at CAQH can assist your team in collecting accurate provider practice information for use in your provider directory contact a member of our Directory Management Services team at the information below.</p> <h1></h1> <p>Use this link to schedule a free demonstration of the solution.</p> <br> <p class="text-align-center"><a href="https://hello.caqh.org/c/smarincaqh-org" style="display:inline-block;border:1px solid rgb(163, 33, 54);border-radius:1px;padding:8px;background:linear-gradient(to bottom,rgb(163, 33, 54),rgb(163, 33, 54));color:rgb(255, 255, 255)" target="blank">Schedule A Demo</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/description" hreflang="en">Description</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/directassure" hreflang="en">DirectAssure</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> Tue, 30 Aug 2022 04:11:46 +0000 lwade@caqh.org 3957 at https://www.caqh.org 3 Challenges and Lessons Learned for FHIR Implementations https://www.caqh.org/about/newsletter/2022/3-challenges-and-lessons-learned-fhir-implementations <span>3 Challenges and Lessons Learned for FHIR Implementations</span> <span><span lang="" about="/users/drogerscaqhorg" typeof="schema:Person" property="schema:name" datatype="">drogers@caqh.org</span></span> <span>Wed, 07/13/2022 - 13:04</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">July 2022</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span><span>On May 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the <a href="https://www.cms.gov/outreach-and-educationoutreachnpcnational-provider-calls-and-events/2020-12-09-interoperability">Interoperability and Patient Access</a> final rule, with the goal of giving patients better access to their health information. Great progress has been made since the rule was enacted. Today <a href="https://www.caqh.org/sites/default/files/explorations/interoperability-and-patient-access.pdf">more than two-thirds of payers</a> have made Patient Access APIs available.  </span></span></span></p> <p><span><span><span>However, health plans still face challenges and barriers with FHIR adoption and must address those obstacles to keep progressing and ensure high priority interoperability needs are met. </span></span></span></p> <p><span><span><span>To gain a better understanding of implementation approaches and lessons learned from the health plans’ experiences, CAQH conducted an informal survey of stakeholders involved in interoperability efforts and found three common themes:</span></span></span></p> <ol><li><span><span><span><b>Competing Priorities Continue to Stall FHIR Implementation Overall </b></span></span></span></li> </ol><p><span><span><span>Over 50 percent of respondents indicated that managing competing priorities persists as the biggest barrier to FHIR implementation. Healthcare organizations are still grappling with the impacts of the COVID-19 pandemic, staffing shortages, and required compliance to other intense regulations like the <a href="https://www.cms.gov/nosurprises">No Surprises Act</a>. Organizational interoperability will require structural changes to support secure data exchanging and shouldn’t be underestimated as a small undertaking for health plans. </span></span></span></p> <ol start="2"><li><span><span><span><b>Member Participation Remains Low</b></span></span></span></li> </ol><p><span><span><span>Low member engagement rates don’t add additional urgency for health plans either. When asked, all plans estimated that between 0 and 5 percent of members have utilized Patient Access APIs. While the goal of the CMS Final Rule is to provide patients better access to their health information, if engagement levels remain low payers won’t see a sense of urgency to improve and enhance these APIs. Also, many app vendors are waiting for payer APIs to mature before investing heavily in integration, and payers have not been working out API issues because low usage has not yet exposed many technical issues. Standardized testing tools, such as <a href="https://www.aegis.net/touchstone/">Aegis Touchstone</a> and certification processes, such as <a href="https://www.drummondgroup.com/compliance/payer-and-patient-access-certification/">Drummond FHIR API Certification</a> can help address these gaps.</span></span></span></p> <ol start="3"><li><span><span><span><b>Security is Still a Top Perceived Concern </b></span></span></span></li> </ol><p><span><span><span>Security was listed as the top concern regarding compliance with FHIR standards. Payers indicated that there is still a concern that patient data could be exposed to unauthorized parties when using FHIR APIs. <a href="https://www.hl7.org/">Health Level Seven (HL7) International</a>, has taken steps to respond and counter those security concerns, however, it’s evident that payers are still hesitant. Common resources and greater guidance on security would help address this gap.</span></span></span></p> <p><span><span><span>Though there has been some <a href="https://www.caqh.org/sites/default/files/explorations/interoperability-and-patient-access.pdf">positive progress</a> towards greater data interoperability over the last two years, there’s still work to be done. Health plan and app vendor commitment to address these challenges and improve the consumer experience would enable the Final Rule to improve interoperability and usher in the next generation of healthcare. </span></span></span></p> <p><span><span><span><a href="https://www.caqh.org/solutions/caqh-endpoint-directory">Learn more</a> about how CAQH is working with app vendors and health plans to support interoperability.</span></span></span></p> </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, 13 Jul 2022 17:04:21 +0000 drogers@caqh.org 3860 at https://www.caqh.org DirectAssure 2.0 Feature Comparison https://www.caqh.org/solutions/directassure-20-feature-comparison <span>DirectAssure 2.0 Feature Comparison</span> <span><span lang="" about="/users/lwadecaqhorg" typeof="schema:Person" property="schema:name" datatype="">lwade@caqh.org</span></span> <span>Fri, 05/06/2022 - 19:22</span> <div class="field field--name-field-subtitle field--type-text-long field--label-hidden field--item"><h2><p>CAQH continues to innovate and enhance DirectAssure. </p> </h2></div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>Recent releases have included features that enable participating organizations to:</p> <ul><li>Meet directory requirements in the Federal "No Surprises Act"</li> <li>Comply with state requirements related to race, ethnicity and language and other    updates</li> <li>Enhance cultural competency and provide directory information of interest to diverse and underserved communities</li> <li>More efficiently and accurately manage data</li> </ul><p><strong>If your organization is using DirectAssure 1.0, you are receiving basic features to meet regulatory requirements:</strong></p> <ul><li>Provider outreach (e.g., phone and email)</li> <li>Compliance reporting</li> <li>Provider directory snapshot with directory confirmation</li> <li>Directory extract</li> </ul><p>If your organization is not using the most recent version, you may not be taking full advantage of what DirectAssure has to offer.   Please contact a member of our <a href="AccountManagement@CAQH.org">Provider Directory Data Improvement Team</a> for additional information and to upgrade.</p> <p> </p> <p><img alt="DirectAssure Version Comparison Chart" data-entity-type="" data-entity-uuid="" src="/sites/default/files/solutions/directassure/DirectAssure%20-%20Features%20Chart%20Graphic_v3.png" /></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/directassure" hreflang="en">DirectAssure</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 23:22:53 +0000 lwade@caqh.org 3840 at https://www.caqh.org 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="2022-03-16T18:00:00Z">March 16, 2022 | 02:00 PM EDT</time> - <time datetime="2022-03-16T19:00:00Z">March 16, 2022 | 03:00 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="https://www.caqh.org/sites/default/files/other/CAQH-AMA_Improving%20Health%20Plan%20Provider%20Directories%20Whitepaper.pdf">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