Article

Section: CORE

Over the years, healthcare industry stakeholders have implemented a multitude of methods connecting applications, systems and networks to exchange administrative and clinical healthcare data. This...

Priority Topics

Section: CORE

As the national operating rule author, CAQH CORE strives to improve the efficiency, accuracy, and effectiveness of industry-driven business transactions by working on priority topics. Additional...

Prior Authorization

Section: CORE

Prior authorization (PA) began as a way to manage the utilization of healthcare resources. It requires providers to request approval from a health plan before a specific procedure, service,...

CAQH White Paper: The Hidden Cause of Inaccurate Provider Directories

Section: Newsletter Article

A recent CAQH survey uncovered the administrative burden on providers associated with maintaining provider directories. The survey of 1,240 physician practices, conducted in September 2019,...

CAQH Achieves HITRUST CSF Certification

Section: Newsletter Article

For the third consecutive year, CAQH has earned certification for information security from the Health Information Trust (HITRUST) Alliance. By earning this status, CAQH has demonstrated that its...

How Unclear Provider Data Contributes to Unexpected Medical Bills

Section: Newsletter Article

In 2018, 57% of Americans received an invoice for services they thought were covered by insurance, also known as a “surprise bill.” Of that group, 20% reported that these charges were the result of...

CAQH CORE and X12 Launch Webinar Series

Section: Newsletter Article

As part of their ongoing work to streamline the business of healthcare, CAQH CORE and X12 are collaborating on a new webinar series. These educational sessions aim to close knowledge gaps and support...

Deadline Extended: Exchanging Medical Documentation Survey

Section: Newsletter Article

CAQH CORE is seeking participants for its survey on the exchange of medical documentation, also known as “attachments.” Since no federally mandated standard for sharing electronic attachments exists...

Industry Progress on Improving Prior Authorizations

Section: Newsletter Article

A standard electronic method for conducting at least a portion of the prior authorization process has been federally mandated since the early 2000s. However, nearly 20 years later, 88 percent of...

Presentation Showcases How Medicaid Plans Can Improve Coordination of Benefits

Section: Newsletter Article

CAQH estimates that administrative inefficiencies associated with coordination of benefits cost the industry $800 million each year. At the Medicaid Health Plans of America (MHPA) Annual Conference,...

CAQH CORE Participant Calendar

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