Important CAQH Updates

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Why the Industry Needs To Lead the Way in Streamlining Healthcare Business Transactions

A recent Catalyst newsletter from the Council for Affordable Quality Healthcare (CAQH) recommends strategies to help healthcare become more efficient.

While the healthcare economy is going digital, an astonishing 40% of claim payments and remittance advices are still done by hand. Even conducting basic transactions requires a minimum of 1.1 million labor hours of manual administrative work each week.

The newsletter provides an interesting comparison between the healthcare and financial services industries. For example, today's banking consumers enjoy and expect global banking, automated cash withdrawals and routine streamlined transactions. Admittedly, the healthcare industry is more complex with many more stakeholders.

But the banking world can provide valuable lessons to our industry, and one important takeaway is that automation became possible in banking because the private and public sectors worked together to develop standards and guidelines. CAQH CORE Operating Rules provide similar paths to a parallel automated environment.

Learn more about streamlining healthcare transactions in the full CAQH CORE issue brief.

Roadmap To Improve Accuracy of Provider Data

Timely and complete provider data is essential when conducting business in the healthcare industry, from paying a claim to developing a provider directory.

But collecting provider data can still be a piecemeal process, with time-consuming and redundant tasks costing the commercial healthcare industry an estimated $2.1 billion each year.

CAQH's Provider Data Action Alliance, a group of health care leaders, has worked hard to develop a Roadmap with a vision and strategies on ways to improve provider data. Some of these recommended strategies include:

  • Centralizing data resources
  • Developing industry-accepted data definitions
  • Improving maintenance processes and accountability measures
  • Fostering greater regulatory alignment

After an industry review period which closes on October 31st, the team's goal is to finalize the Roadmap in November. Read more about the team's approach in this Roadmap slide show and stay tuned for updates later this year.

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