Transcript Document

CAQH New Initiatives Overview
NCF 2015 Meeting
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CAQH – Catalyst for Industry Collaboration
CAQH, a non-profit alliance, is the leader in creating shared
initiatives to streamline the business of healthcare. Through
collaboration and innovation, CAQH accelerates the
transformation of business processes, delivering value to
providers, patients and health plans.
• CAQH initiatives are national in scope and produce measurable
results.
– Help promote quality interactions between plans, providers and other
stakeholders.
– Reduce costs and frustrations associated with healthcare administration.
– Facilitate administrative healthcare information exchange.
– Encourage administrative and clinical data integration.
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CAQH Members
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Current Initiatives
Industry-wide, multi-stakeholder collaboration to facilitate development
and adoption of national operating rules for administrative transactions.
Service that replaces multiple paper processes for collecting provider
data with a single, electronic, uniform data-collection system (e.g.,
credentialing).
Service that enables providers to enroll in electronic payments with
multiple payers and manage their electronic payment information in one
location, automatically sharing updates with selected payer partners.
COB Smart
Industry-wide registry of coverage status information that enables
health plans and providers to identify individuals with multiple forms of
coverage to ensure claims are processed correctly the first time.
Objective industry collaboration tracking progress and savings
associated with adopting electronic solutions for administrative
transactions across the industry.
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Universal Provider Datasource – Today and Tomorrow
Today’s Model – Efficient Distribution
Physicians
Tomorrow’s Model – High Quality Information Provider
Capture
Credentialing
Application
Information
Physicians
Health Plans
& Other
Organizations
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Help to process a transaction - take information from
providers, package it, and distribute it to one of more
organizations.

Providers mainly come to UPD when they are asked
to reattest every 120 days; payers mostly only use
our information for credentialing, but may use it for
other needs.

Focus: Credentialing Attestation Event

Required to support:
 Credentialing form electronic data capture
 Process focused operations
 File distribution
Manage
Information
Profile
Data
Maintenance
& Validation
Health Plans
& Other
Organizations

Provide up to date information on providers, and
actively maintain and validate data for accuracy.

Providers want to come to UPD often and keep their
information up to date and accurate; organizations
direct providers to UPD through various motivation.

Focus: Provider Profile

Required to support:
 Profile electronic data capture
 Data quality focused operations
 Third party data
 Robust data access
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EnrollHub - EFT Enrollment Solution Overview
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Web-based data entry for provider EFT enrollment information.
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Alignment with CORE ERA / EFT Operating Rules for definition of the standard
enrollment data set and supporting documents.
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Web-based access portal for health plan customers.
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Provider adoption campaigns / integration with UPD to electronically promote the
CAQH EFT enrollment utility to UPD provider users.
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Provider support center.
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Voided check and other uploaded document processing.
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Pre-note transactions via ACH partners to validate bank account information.
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COB Smart – Solving the Coordination of Benefits
Problem
Does the patient
have multiple
coverage? Which
insurer is primary?
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Current State Inefficiencies
Patient paperwork
COB denials and resubmissions
Overpayment recoveries
Appeals and grievances
Current state administrative Costs
• More than $800M annually
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COB Smart Objectives
• Identify individuals with overlapping
coverage across
• Where possible, determine the
correct order of benefits
• Share accurate and complete COB
information with appropriate
providers and health plans
multiple health plans
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Questions
Sorin Davis
Managing Director, Business Development
[email protected]
914-693-6934
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