Health plans https://www.caqh.org/ en Current Initiatives for CAQH CORE Participants https://www.caqh.org/core/current-initiatives-caqh-core-participants <span>Current Initiatives for CAQH CORE Participants</span> <span><span lang="" about="/users/cmassiecaqhorg" typeof="schema:Person" property="schema:name" datatype="">cmassie@caqh.org</span></span> <span>Thu, 01/14/2021 - 20:15</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>CAQH CORE Participating Organizations help ensure that operating rules continue to meet evolving business needs, by engaging in the rule development process and maintenance of existing operating rules. Work groups are open to all CAQH CORE Participating Organizations, and multiple individuals from the same Participating Organization may join. Because each organization has only one vote, participants collaborate with their colleagues to submit an organizational-level response during voting periods. </p> <p>Below is a list of CAQH CORE work groups that currently convene or are upcoming as well as initiatives that are underway. In addition to contributing to these work groups and initiatives, as well as the formal CAQH CORE <a href="https://www.caqh.org/core/voting-process"><span>voting process</span></a>, Participating Organizations benefit from exclusive education content and research opportunities.</p> <table border="0" cellpadding="0" cellspacing="0" width="610"><tbody><tr><td> <p><span>Initiative </span></p> </td> <td> <p><span>Focus</span></p> </td> <td> <p><span>Current Objectives</span></p> </td> <td> <p><span>Co-Chairs</span></p> </td> <td> <p><span>Cadence</span></p> </td> </tr><tr><td><strong><span><span><span><span>Eligibility &amp; Benefits Task Group</span></span></span></span></strong></td> <td>Rule Development</td> <td>Update the Eligibility &amp; Benefits Data Content Rule to address emerging industry needs (such as support more STC codes, tiered benefits, procedure-level, # of remaining visits/services, telemedicine).</td> <td>TBD</td> <td>TBD</td> </tr><tr><td> <p><strong>Pilot &amp; Measurement Initiative</strong></p> </td> <td> <p>Prior Authorization &amp; Attachments; Quality Measures Reporting</p> </td> <td> <p><span class="normaltextrun"><span>Work with other CORE Participating Organizations and CAQH to <b>measure the impact of potential operating rules and corresponding standards on entities’ efficiency metrics.</b></span></span></p> </td> <td><span>N/A</span></td> <td> <p>N/A</p> </td> </tr><tr><td><strong>Attachments Subgroup (Prior Authorization Use Case)</strong></td> <td>Rule Development</td> <td>Develop operating rules to <strong>improve automation of the exchange of attachments/additional medical document</strong>; initial focus on prior authorization use case.</td> <td> <p><strong>Santo Carino</strong><span>, Epic</span></p> <p><strong>Bob Gross  </strong>Cleveland Clinic</p> <p><strong>Mahesh Siddanthi</strong>, Centene</p> </td> <td>Monthly, adjourning March 2021</td> </tr><tr><td><strong><span>Attachments Subgroup (Claims Use Case)</span></strong></td> <td><span>Rule Development</span></td> <td>Following the prior authorization use case, evelop operating rules to <strong>improve automation of the exchange of attachments/additional medical document</strong>; with a focus on claims attachments.</td> <td> <p>TBD</p> </td> <td> <p><span>Launching Q2, meeting monthly through Q3.<span>  </span></span></p> </td> </tr><tr><td> <p><strong>CORE <u><a href="https://www.caqh.org/core/ongoing-maintenance-core-code-combinations">Code Combinations</a></u> Task Group</strong></p> </td> <td> <p>Rule Maintenance</p> </td> <td> <p>Ensure compliance with the <strong>base standard code lists – CARCs and RARCs</strong>. Conduct annual industry survey to collect suggestions for potential market-driven adjustments to code combinations.</p> </td> <td> <p><strong>Shannon Baber</strong>, UW Medicine          <strong>Nathan Fisk</strong>, Change Healthcare        <strong>Lynn Franco</strong>,  UnitedHealth Group  <strong>Heather Morgan</strong>,  Aetna</p> </td> <td> <p>Once every 2-3 months, for a total of 6 times a year</p> </td> </tr></tbody></table><p> If you would like to join any of the following initiatives, please contact <a href="mailto:core@caqh.org">core@caqh.org</a>.  </p> </div> <div class="field field--name-field-taxonomy-type field--type-entity-reference field--label-inline"> <div class="field--label">Type</div> <div class="field--item"><a href="/type/article" hreflang="en">Article</a></div> </div> <div class="field field--name-field-taxonomy-audience field--type-entity-reference field--label-inline"> <div class="field--label">Audience</div> <div class="field--item"><a href="/target-audience/public" hreflang="en">Public</a></div> </div> <div class="field field--name-field-taxonomy-organization-type field--type-entity-reference field--label-inline"> <div class="field--label">Organization Type</div> <div class="field--item"><a href="/organization/health-plans" hreflang="en">Health plans</a></div> </div> <div class="field field--name-field-taxonomy-caqh-program field--type-entity-reference field--label-inline"> <div class="field--label">CAQH Program</div> <div class="field--item"><a href="/programsolution/core" hreflang="en">CORE</a></div> </div> Fri, 15 Jan 2021 01:15:04 +0000 cmassie@caqh.org 2207 at https://www.caqh.org 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="http://www.caqh.org/core/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 Call for Contributions: The 2020 CAQH Index https://www.caqh.org/about/newsletter/2020/call-contributions-2020-caqh-index <span>Call for Contributions: The 2020 CAQH Index </span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 07/29/2020 - 15:51</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>Each year, CAQH publishes a report that tracks the progress the healthcare industry is making toward automating business transactions. For example, the <a href="https://www.caqh.org/sites/default/files/explorations/index/report/2019-caqh-index.pdf?token=SP6YxT4u">2019 CAQH Index</a> found that the medical and dental industry could save an additional $13.3 billion dollars annually by automating administrative transactions.</p> <p>This research is made possible through the voluntary participation of stakeholders from across healthcare.</p> <p>Data collection is underway for this year’s report. In return for their contributions, participants will receive a personalized report with custom insights that allow organizations to compare their progress against industry benchmarks. All healthcare provider/plan organizations, vendors, federal and state agencies, and PBMs are encouraged to participate.</p> <p>The 2020 CAQH Index will also dig deeper into one of the industry’s leading frustrations: prior authorization.</p> <p>To contribute to the 2020 CAQH Index, complete the appropriate survey link below <strong>by August 20</strong>. All collected data is kept completely confidential.</p> <ul><li><a href="https://norc.az1.qualtrics.com/jfe/form/SV_cT6fjRKwisw1XNz">Medical and Dental Provider Survey</a></li> <li><a href="https://caqh.co1.qualtrics.com/jfe/form/SV_6GuOWtzvrIWWocd">Medical Plan Survey</a></li> <li><a href="https://caqh.co1.qualtrics.com/jfe/form/SV_cFQ2rhcwhwKRelv">Dental Plan Survey</a></li> </ul><p>For more information or questions about data contribution, please contact <a href="mailto:explorations@caqh.org">explorations@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/caqh-large" hreflang="en">CAQH at Large</a></div> </div> Wed, 29 Jul 2020 19:51:15 +0000 mnew@caqh.org 3054 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 CAQH CORE to Lead Sessions at WEDI Forum https://www.caqh.org/about/newsletter/2020/caqh-core-lead-sessions-wedi-forum <span>CAQH CORE to Lead Sessions at WEDI Forum </span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 07/29/2020 - 15:43</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>CAQH CORE will be playing an active role in this year’s <a href="https://members.wedi.org/event-calendar/Details/wedi-forum-155579?sourceTypeId=Website">WEDI Forum</a>, and leading two sessions during the three-day event:</p> <ul><li>Wednesday, August 5th, from 11:30 am - 12:00 pm ET - The CAQH CORE team will be conducting an interactive presentation about the value of earning a CAQH CORE Certification.</li> <li>Thursday, August 6th, from 12:30 - 1:15 pm ET - CAQH CORE Director, Robert Bowman, will give a CAQH CORE update, including recent rule development activities on prior authorization, connectivity, value-based payments and attachments to support standardization in the exchange of administrative and clinical data.</li> </ul><p>For more information about the WEDI Forum, <a href="https://members.wedi.org/event-calendar/Details/wedi-forum-155579?sourceTypeId=Website">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, 29 Jul 2020 19:43:11 +0000 mnew@caqh.org 3052 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 Ensuring Accurate Coordination of Benefits During Remote Work https://www.caqh.org/about/newsletter/2020/ensuring-accurate-coordination-benefits-during-remote-work <span>Ensuring Accurate Coordination of Benefits During Remote Work </span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 06/24/2020 - 10:42</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>Managing coordination of benefits (COB) is challenging for many health plans, but Medicaid plans face among the greatest obstacles. For example, Medicaid beneficiaries often have multiple breaks in coverage in a single year, resulting in data becoming outdated quickly. These plans also have limited resources for identifying third-party liability, although they are required by law to do so.</p> <p>And now, as team members involved in COB work remotely, these hurdles can become even greater.</p> <p>In a new white paper, CAQH outlines common pitfalls associated with coordinating benefits and identifying third-party liability, and offers recommendations for how Medicaid programs can utilize high-quality data and more efficient workflows to overcome them. <a href="https://ok.caqh.org/social/Twitter/COB-Smart/CAQH/ui/e37HOK?utm_medium=Social&amp;utm_source=Twitter&amp;utm_term=&amp;utm_campaign=COB+Smart&amp;utm_content=UI&amp;okt_campaign_id=002vx9bnbz7ze5n&amp;okt_profile_name=CAQH%27s+Twitter&amp;okt_profile_id=003-0014zeaaosdbhbd-549694513&amp;okt_poster_name=Marketing+CAQH&amp;okt_poster_id=00Abbii7ajzidqr&amp;okt_post_id=004gjds2dts3lub&amp;okt_message_id=005rflzfhom3kgw&amp;okt_remote_url=http%3A%2F%2Ftwitter.com%2FCAQH%2Fstatus%2F1268232240577875970&amp;oktgid=cm1W0ESJmogWwiKDY9kOuJTug3PWuRyd">Read more.</a></p> <p>To learn how COB Smart can help Medicaid programs improve their coordination of benefits process, <a href="https://www.caqh.org/solutions/cob-smart-medicaid-plans">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 14:42:37 +0000 mnew@caqh.org 3046 at https://www.caqh.org