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CAQH New Initiatives Overview NCF 2015 Meeting

CAQH New Initiatives Overview NCF 2015 Meeting. CAQH – Catalyst for Industry Collaboration.

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CAQH New Initiatives Overview NCF 2015 Meeting

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  1. CAQH New Initiatives OverviewNCF 2015 Meeting

  2. 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.

  3. CAQH Members

  4. 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. 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. Current Initiatives COB Smart

  5. Universal Provider Datasource – Today and Tomorrow Today’s Model – Efficient Distribution Tomorrow’s Model – High Quality Information Provider Capture Credentialing Application Information Manage Information Profile Health Plans & Other Organizations Health Plans & Other Organizations Data Maintenance & Validation • 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 Physicians Physicians • 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

  6. EnrollHub - EFT Enrollment Solution Overview • Web-based data entry for provider EFT enrollment information. • Alignment with CORE ERA / EFT Operating Rules for definition of the standard enrollment data set and supporting documents. • Web-based access portal for health plan customers. • Provider adoption campaigns / integration with UPD to electronically promote the CAQH EFT enrollment utility to UPD provider users. • Provider support center. • Voided check and other uploaded document processing. • Pre-note transactions via ACH partners to validate bank account information.

  7. COB Smart – Solving the Coordination of Benefits Problem Current State Inefficiencies • Patient paperwork • COB denials and resubmissions • Overpayment recoveries • Appeals and grievances Current state administrative Costs • More than $800M annually 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 plansmultiple health plans Does the patient have multiple coverage? Which insurer is primary?

  8. Questions Sorin Davis Managing Director, Business Development sdavis@caqh.org 914-693-6934

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