VeriFide https://www.caqh.org/ en Efficient Credentialing Has Never Been More Important for Medicaid Plans https://www.caqh.org/about/newsletter/2021/efficient-credentialing-has-never-been-more-important-medicaid-plans <span>Efficient Credentialing Has Never Been More Important for Medicaid Plans</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Mon, 02/08/2021 - 16:15</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">February 2021</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p><span><span>The healthcare industry is facing unprecedented challenges. Medicaid plans, in particular, are navigating significant increases in enrollment and new strains on their time and resources. </span></span><span><span>Your credentialing primary source verification process (PSV) shouldn’t add to your burden. </span></span></p> <p><span><span>VeriFide™ is seamlessly integrated into CAQH ProView, which is used by more than 1.6 million providers to exchange professional information with payers for commercial, Medicare and Medicaid programs. </span></span></p> <p><span><span>VeriFide enables users to: </span></span></p> <ul><li><span><span>Achieve 98.5% PSV file accuracy and completeness through greater automation, diligent CAQH follow-up and improved provider responses. </span></span></li> <li><span><span>Shorten the credentialing cycle, returning 95% of the initial files within 11-14 days, and 100% of re-credentialed files 60 days before the provider’s target date. </span></span></li> <li><span><span>Reduce time from initial credentialing to network participation and payment. </span></span></li> <li><span><span>Lower costs and reduce outreach by aligning the timing of provider credentialing events across organizations. </span></span></li> </ul><p><span><span>The Medicaid screening service that is built into VeriFide performs Death Master File, National Provider and Plan Enumeration System (NPPES), and state exclusion research. </span></span></p> </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> Mon, 08 Feb 2021 21:15:52 +0000 mnew@caqh.org 3166 at https://www.caqh.org Verifying Provider Credentials is Easier than Ever https://www.caqh.org/about/newsletter/2019/verifying-provider-credentials-easier-ever <span>Verifying Provider Credentials is Easier than Ever</span> <span><span lang="" about="/users/mnewcaqhorg" typeof="schema:Person" property="schema:name" datatype="">mnew@caqh.org</span></span> <span>Wed, 01/30/2019 - 13:26</span> <div class="field field--name-field-display-date field--type-timestamp field--label-hidden field--item">January 2019</div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>The credentialing process can be cumbersome for both healthcare providers and health plans. After provider data collection, health plans defer credentialing decisions until they complete primary source verification (PSV). The PSV process is often time-consuming and results in redundant outreach as multiple plans request the same information from a provider.<!--break--></p> <p>For health plans looking to reduce the burden of provider data verification, <a href="https://www.caqh.org/solutions/verifide">VeriFide</a><sup>TM </sup>can help. This automated CAQH Solution authenticates the accuracy and completeness of credentialing information submitted by healthcare providers to plans. It not only addresses the inefficiencies of PSV but also provides a cost-effective approach that reduces manual intervention through system integrations and the automation of primary source queries.</p> <p>VeriFide returns 98 percent of initial files to a plan for credentialing decisions in just 14 days, with 98.5 percent accuracy and completeness.</p> <p>Upcoming new features include a self-service portal that enables plans to track credentials – either one provider at a time, or in batches – throughout the primary source verification process. This real-time visibility will make it easier for health plans to update providers about their credentialing status and when they will be able to participate in the network.</p> <p>With VeriFide, the credentialing process is faster, more accurate and less costly. It also significantly reduces the “chase work” involved in finding primary data sources.</p> <p><a href="https://www.caqh.org/solutions/verifide">Click here</a> to learn more about VeriFide and how it can reduce credentialing difficulties.</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> Wed, 30 Jan 2019 18:26:36 +0000 mnew@caqh.org 2272 at https://www.caqh.org The Ultimate Guide to Building a Seamless Provider Credentialing Process https://www.caqh.org/about/event/ultimate-guide-building-seamless-provider-credentialing-process <span>The Ultimate Guide to Building a Seamless Provider Credentialing Process </span> <span><span lang="" about="/users/cmassiecaqhorg" typeof="schema:Person" property="schema:name" datatype="">cmassie@caqh.org</span></span> <span>Wed, 09/26/2018 - 13:10</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="2018-10-17T18:30:00Z">October 17, 2018 | 02:30 PM EDT</time> - <time datetime="2018-10-17T19:30:00Z">October 17, 2018 | 03:30 PM EDT</time> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>Manual and time-consuming processes, human data entry errors, incomplete files, fluctuations in workload, costly data acquisition fees, and provider abrasion are a few reasons why health plans are exploring opportunities to improve their credentialing process.  <br />  <br /> If you’re like most health plans, chances are you are somewhere between making a few tweaks or rebuilding your process.  Wherever you may be on the credentialing process spectrum, you need a guide to establish a baseline and chart your progression. <br /><br /> Join our industry leaders, Ron Urwongse and Tarun Theogaraj, CAQH Senior Product Managers, Provider Data and Credentialing Solutions, as they guide you through the process of taking your provider credentialing process to the next level.</p> <h4>Resource: <a href="http://go.caqh.org/l/339361/2018-10-24/4gh4x">Presentation Recording</a></h4> </div> <span class="a2a_kit a2a_kit_size_36 addtoany_list" data-a2a-url="https://www.caqh.org/about/event/ultimate-guide-building-seamless-provider-credentialing-process" data-a2a-title="The Ultimate Guide to Building a Seamless Provider Credentialing Process "><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/verifide" hreflang="en">VeriFide</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, 26 Sep 2018 17:10:45 +0000 cmassie@caqh.org 2223 at https://www.caqh.org Proven Tactics for Improving Your Provider Credentialing Process https://www.caqh.org/about/event/proven-tactics-improving-your-provider-credentialing-process <span>Proven Tactics for Improving Your Provider Credentialing Process</span> <span><span lang="" about="/users/cmassiecaqhorg" typeof="schema:Person" property="schema:name" datatype="">cmassie@caqh.org</span></span> <span>Wed, 08/01/2018 - 16:57</span> <div class="field field--name-field-subtitle field--type-text-long field--label-hidden field--item"><h2><p>A Blue Cross and Blue Shield of Alabama Case Study</p> </h2></div> <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="2018-08-15T18:00:00Z">August 15, 2018 | 02:00 PM EDT</time> - <time datetime="2018-08-15T19:00:00Z">August 15, 2018 | 03:00 PM EDT</time> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>Costly data acquisition fees and human entry errors, incomplete files, manual processes, and provider abrasion are a few reasons why Blue Cross and Blue Shield of Alabama (BCBSAL) explored opportunities to improve their provider [re]credentialing, primary source verification and sanctions monitoring process. <br />  <br /> With the Credentialing Suite by CAQH, the BCBSAL team significantly reduced its provider outreach and credentialing cycle by 60-days, improved data quality, insured consistent data queries and evaluation for sanctions tracking, and streamlined internal processes to improve the overall cost.<br />  <br /> Join representatives from BCBSAL and CAQH as they discuss specific tactics and best practices for constructing an efficient end-to-end [re]credentialing process. </p> <p> </p> <h4>Resource: <a href="http://bit.ly/2OCMH6i">Presentation recording</a></h4> </div> <span class="a2a_kit a2a_kit_size_36 addtoany_list" data-a2a-url="https://www.caqh.org/about/event/proven-tactics-improving-your-provider-credentialing-process" data-a2a-title="Proven Tactics for Improving Your Provider Credentialing Process"><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/verifide" hreflang="en">VeriFide</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, 01 Aug 2018 20:57:27 +0000 cmassie@caqh.org 2183 at https://www.caqh.org Making the Business Case For Credentialing Automation https://www.caqh.org/about/event/making-business-case-credentialing-automation <span>Making the Business Case For Credentialing Automation</span> <span><span lang="" about="/users/cmassiecaqhorg" typeof="schema:Person" property="schema:name" datatype="">cmassie@caqh.org</span></span> <span>Wed, 08/01/2018 - 16:55</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="2018-08-09T19:00:00Z">August 09, 2018 | 03:00 PM EDT</time> - <time datetime="2018-08-09T20:00:00Z">August 09, 2018 | 04:00 PM EDT</time> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>Explore opportunities to integrate health plan functions with CAQH Solutions to enable cost savings, increase quality and accuracy, and speed provider on-boarding. <br /><br /> Join representatives from, BlueCross BlueShield of Tennessee (BCBSTN), and CareFirst BlueCross BlueShield for a discussion of their health plan experiences automating enrollment and primary source verification (PSV) automation:</p> <ul><li>Discover why BCBSTN decided to integrate their provider enrollment process with CAQH, their approach and lessons learned, and immediate improvements to key process indicators.</li> <li>Learn how CareFirst, a customer of VeriFide, launched a project to automate the intake of VeriFide’s PSV outputs, how it changed their processes, and their goals for turnaround time and automation.</li> </ul><p> </p> <h4>Resource: <a href="http://bit.ly/2P6K5ia">Presentation recording</a> </h4> </div> <span class="a2a_kit a2a_kit_size_36 addtoany_list" data-a2a-url="https://www.caqh.org/about/event/making-business-case-credentialing-automation" data-a2a-title="Making the Business Case For Credentialing Automation"><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/verifide" hreflang="en">VeriFide</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, 01 Aug 2018 20:55:36 +0000 cmassie@caqh.org 2182 at https://www.caqh.org A Tale of Three Credentialing Departments – How Health Plans are Achieving Their Primary Source Verification Objectives Despite Limited Automation https://www.caqh.org/about/event/tale-three-credentialing-departments-how-health-plans-are-achieving-their-primary <span>A Tale of Three Credentialing Departments – How Health Plans are Achieving Their Primary Source Verification Objectives Despite Limited Automation</span> <span><span lang="" about="/users/mwoolstoncaqhorg" typeof="schema:Person" property="schema:name" datatype="">mwoolston@caqh.org</span></span> <span>Mon, 05/14/2018 - 09:38</span> <div class="field field--name-field-subtitle field--type-text-long field--label-hidden field--item"><h2><h1>The Midday Download, brought to you by CAQH</h1> </h2></div> <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="2018-04-25T17:00:00Z">April 25, 2018 | 01:00 PM EDT</time> - <time datetime="2018-04-25T17:20:00Z">April 25, 2018 | 01:20 PM EDT</time> </div> <div class="field field--name-field-location field--type-text-with-summary field--label-hidden field--item"><p><strong><a href="/go.caqh.org/l/339361/2018-04-25/32znh">On Demand Webinar</a></strong></p> </div> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><p>The hub of an efficient primary source verification (PSV) process is automation.  However, for many health plans, mechanizing data extraction, evaluation, and categorization may be delayed due to competing departmental priorities, cost, and limited IT resources.<br /><br /> During our<strong> <a href="http://go.caqh.org/l/339361/2018-04-25/32znh">20-minute discussion</a></strong>, we review how three health plans changed their processes to meet the immediate demands of larger provider networks and tighter deadlines without hiring additional staff or building a fully automated process - while still setting the stage for future automation.  </p> </div> <span class="a2a_kit a2a_kit_size_36 addtoany_list" data-a2a-url="https://www.caqh.org/about/event/tale-three-credentialing-departments-how-health-plans-are-achieving-their-primary" data-a2a-title="A Tale of Three Credentialing Departments – How Health Plans are Achieving Their Primary Source Verification Objectives Despite Limited Automation"><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/verifide" hreflang="en">VeriFide</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> Mon, 14 May 2018 13:38:23 +0000 mwoolston@caqh.org 2135 at https://www.caqh.org VeriFide FAQs for Providers and Practice Managers https://www.caqh.org/solutions/verifide-faqs-providers-and-practice-managers <span>VeriFide FAQs for Providers and Practice Managers</span> <span><span lang="" about="/users/cmassiecaqhorg" typeof="schema:Person" property="schema:name" datatype="">cmassie@caqh.org</span></span> <span>Mon, 04/03/2017 - 17:06</span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field--item"><h5>Why was VeriFide developed? </h5> <p>Both health plans and healthcare providers have expressed concern about the inefficient, repetitive process associated with the verification of provider data during credentialing and re-credentialing/</p> <p>In order to reduce these inefficiencies, CAQH worked with our member health plans to develop a new solution designed to more accurately, completely and easily verify provider data. Our goal is to reduce the burden for plans and providers inherent in the current process. </p> <h5><span>Is CAQH a certified credentials verification organization (CVO)?</span></h5> <p>Yes, CAQH is certified as a <a href="http://www.caqh.org/sites/default/files/ncqa-certificates.pdf?token=x3P82BiJ">Credentials Verification Organization</a> (CVO) through the National Committee for Quality Assurance (NCQA). </p> <h5>How does VeriFide work?</h5> <p>VeriFide leverages data from CAQH ProView<sup>®</sup>, which is trusted by over 1.6 million providers to report and regularly attest to their professional and practice information. </p> <p>Supported by an experienced staff, VeriFide uses advanced automated technologies to compare the self-reported provider information to primary sources for accuracy. </p> <p>CAQH uses the NCQA standardized set of 14 data elements to verify each provider’s professional information:</p> <ul><li>License to practice</li> <li>DEA and CDS certificates</li> <li>Education and training </li> <li>Board certification</li> <li>Work history</li> <li>Malpractice history (NPDB)</li> <li>License sanctions (NPDB)</li> <li>Medicare/Medicaid Sanctions (NPDB)</li> <li>Hospital privileges</li> <li>Current malpractice coverage</li> <li>Current attestation and disclosure questions</li> <li>Office of the Inspector General sanction check</li> <li>System for Award sanction check</li> <li>Medicare opt-out check</li> </ul><p>Where necessary, VeriFide staffers may contact the provider to confirm specific information. </p> <h5>How is VeriFide different from other primary source verification solutions?</h5> <p>What differentiates VeriFide from other primary source verification solutions is its:</p> <ul><li><strong>Seamless integration with CAQH ProView.</strong> <ul><li>VeriFide is able to automatically access the provider data in CAQH ProView to begin the verification process.</li> </ul></li> <li><strong>Automation with most primary data sources.</strong> <ul><li>VeriFide deploys advanced automated technologies that compare each provider’s information against primary data sources for accuracy.  By reducing manual processes, it takes less time to work on a provider file, and also reduces the likelihood of human error.  </li> </ul></li> <li><strong>Standardization of data elements for quicker credentialing.</strong> <ul><li>Each health plan participating in VeriFide agrees to use the industry-wide, standard set of NCQA key data elements that must be verified. This is the information deemed essential for the credentialing process.</li> </ul></li> <li><strong>Industry-wide alignment of provider credentialing dates.</strong> <ul><li>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 inefficient and duplicative process, over time VeriFide will align credentialing dates for providers, so that each will have a dedicated recredentialing date among all health plans.   </li> </ul></li> </ul><h5>What are the benefits that providers will experience using VeriFide?</h5> <p>When health plans use VeriFide, the providers in their networks should experience:</p> <ul><li>A reduction in time from initial credentialing to network participation and payment.</li> <li>Reduced outreach to practice staff by multiple health plans. </li> <li>Less confusion caused by inconsistent credentialing requirements across plans.</li> <li>Dynamic updates to all participating plans designated by the provider.</li> </ul><h5>Please explain the process by which VeriFide will align the provider credentialing dates across the industry. </h5> <p>Each health plan is required by NCQA to re-credential healthcare providers in their network every three years. VeriFide will create an “anchor date.” This is a specific month within the 36-month cycle when the provider will be re-credentialed for all participating health plans.</p> <p>To achieve this anchor date, each health plan’s re-credential date for a provider will be brought forward (i.e., moved up earlier) several months each year to bring it closer to the anchor date.  Since re-credentialing dates for each provider vary greatly from plan-to-plan, it will take several years to achieve this goal. So that providers remain compliant with NCQA requirements during this transition, the re-credential date will be progressively moved earlier, and never moved later.</p> <p>Once this alignment goal is achieved across the industry, each provider’s data will only need to be verified once, at a specific point in time, every three years. Their information will be shared concurrently with each health plan participating in VeriFide.</p> <h5>Will healthcare providers be charged a fee to participate in this service?</h5> <p>VeriFide will utilize the data entered into CAQH ProView to complete verification, which will continue to be available free of charge to providers.</p> <h5>What do I need to do to participate in this solution?</h5> <p>Providers currently using CAQH ProView should continue to maintain their data profiles, updating their information and re-attesting when necessary.</p> <p>When a provider’s contracted health plans begin to use VeriFide for the credentialing process, access to the most up-to-date provider data in CAQH ProView will help speed the verification process.</p> <h5>How can I encourage the health plans with which I contract to use VeriFide?</h5> <p>Please inform your network health plans that you would like them to use VeriFide for the credentialing verification process. They should <a href="https://www.caqh.org/solutions/request-product-demo">schedule a product demo</a>. </p> <h5>Where can I go for more information? </h5> <p>Visit the <a href="http://www.caqh.org/solutions/primary-source-verification">CAQH website</a> for more information about this solution.</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/healthcare-providers" hreflang="en">Healthcare providers</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> Mon, 03 Apr 2017 21:06:08 +0000 cmassie@caqh.org 1894 at https://www.caqh.org