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As the current and immediate past Chairs of the CAQH CORE Board, we are excited to discuss the operating rule package currently under consideration for federal mandate. Below we will review the path to federal mandate, the proposed rules, and what to expect next.
Value-based payment (VBP) models pay providers based on the outcomes of the care they deliver, not the volume. VBP models are recognized for their potential to lower costs, increase quality, and promote equity. Almost 60% of healthcare payments are tied to some form of value, be it through pay-for-performance incentives - such as payment add-ons for controlling chronic conditions in a patient population - or shared-risk arrangements between providers and payers, like population-health models that measure performance against a total cost of care benchmark.
Recent releases have included features that enable participating organizations to:
If your organization is using DirectAssure 1.0, you are receiving basic features to meet regulatory requirements:
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.
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.
CAQH has released the ninth annual report measuring the progress healthcare payers and providers are making to use electronic business processes.
The No Surprises Act of 2021 takes another step toward mandating that health plans improve the accuracy of their provider directories. The Act includes specific requirements health plans must meet by January 2022. Are you ready? Download the brief to learn more, and request a demonstration today.
The annual report tracks trends in automation, spending and savings opportunities for healthcare administrative transactions.
CAQH has released the eighth annual report measuring the progress made by healthcare payers and providers in automating administrative transactions. The 2020 CAQH Index found that, of the $372 billion widely cited as the cost of administrative complexity in the US healthcare system, the industry can save $16.3 billion by fully automating nine common transactions.
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.
The CAQH CORE FAQs are in the process of being updated. CAQH CORE appreciates your patience as these updates are made.
CAQH CORE has produced a variety of online resources to provide education on operating rule implementation and CAQH CORE initiatives.
CAQH CORE has developed interactive tools and dashboards on topics of interest to industry stakeholders.
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