[[{"fid":"6622","view_mode":"default","fields":{"format":"default","field_file_image_alt_text[und][0][value]":"Modern Healthcare Best Places Award 2018","field_file_image_title_text[und][0][value]":"Modern Healthcare Best Places Award 2018","field_folder[und]":"108","field_binary_asset_section[und]":"115","field_public[und]":"1","field_file_description[und][0][value]":"","field_file_description[und][0][format]":"full_html"},"type":"media","prev_link_text":"Modern Healthcare Best Places Award 2018","attributes":{"alt":"Modern Healthcare Best Places Award 2018","title":"Modern Healthcare Best Places Award 2018","style":"width: 600px; margin-left: 20px; margin-right: 20px;","class":"media-element file-default"}}]] Modern Healthcare recognized CAQH on its list of the Best Places to Work in Healthcare for 2018. This is the third year in a row that CAQH has been included on the list of 150 organizations and companies across the U.S. that “stand out in their efforts to create an empowered and satisfied workforce.”

The U.S. healthcare economy is undergoing a transformation in how care is measured, billed and paid. Organizations around the country are shifting away from fee-for-service models that reimburse providers for the volume of care, and experimenting with value-based payment models, which align quality of care and cost controls with provider compensation. As value-based payment innovation continues, there are many threats to its progress, such as operational challenges.

In its second year of adoption, DirectAssure has established itself as a leading solution for health plans to address the ongoing challenge of maintaining accurate provider directories. Making changes to directory information is seamless for healthcare providers, who use CAQH ProView to easily review and update their professional information. DirectAssure participating organizations, including most national plans, are already using the solution to manage directory data for more than 800,000 providers. On average, about 600,000 of those providers review and confirm their information every four months, demonstrating a high level of engagement with CAQH.

CAQH, a nonprofit alliance of health plans and related associations, recently received the “Excellence in Health IT Award” from the Workgroup for Electronic Data Interchange (WEDI). Presented during the WEDI annual meeting on December 6, the award recognizes organizations and individuals that have made outstanding contributions to the advancement of information technology (HIT) and eCommerce technology in healthcare.

Organizations can now become CORE-certified in the Phase IV operating rules for exchanging administrative data electronically. The rules help streamline prior authorization, healthcare claims, employee premium payments, health plan enrollment and disenrollment, and other transactions.

Improving provider directory accuracy continues to be an industry-wide challenge. Periodic reviews from the Centers for Medicare and Medicaid Services (CMS) have intensified pressure on health plans to improve the quality of directories. Plans allocate significant resources to these efforts, which are a portion of the $2 billion spent annually by the commercial healthcare industry to maintain provider data.

In an effort to reduce administrative burdens for all dentists, the ADA and CAQH have formed a strategic alliance to help streamline the credentialing process for dentists, dental plans and employers. The ADA® credentialing service, powered by CAQH ProView®, enables dentists to enter their professional and practice information one time in an easy-to-use, fast and protected digital platform. ADA is widely promoting this service to all U.S. practicing dentists, including its membership of 161,000 dentists. The number of dentists participating in CAQH ProView is expected to increase substantially, making it the leading industry source for dentists’ credentialing data.

The credentialing verification process in healthcare can be inefficient. Health plans often use manual processes to verify provider information, which can lead to errors and incomplete files. Delays in the process also contribute to long lead times before a provider can join a new network. Opportunities to lower costs and increase file accuracy are a few reasons why health plans are exploring ways to improve their provider credentialing process and reduce administrative burdens.

The healthcare economy is going digital. However, a minimum of 1.1 million labor hours of manual administrative work goes into conducting basic transactions each week. For example, up to 40 percent of claim payments and remittance advices, are still done the old-fashioned way—by hand. The financial services industry offers an interesting comparison. Today, consumers enjoy automated cash withdrawals, global banking and routine streamlined transactions. While healthcare is a more complex industry with many more stakeholders, there are lessons that can be applied from the banking world.

There has long been an industry imperative to improve the quality of information in health plan provider directories. Over the last two years, new federal and state regulations have added pressure, requiring strategies that prioritize error removal and strengthen provider engagement. Federal regulations now require Medicare Advantage, Medicaid and Qualified Health Plans to conduct routine provider outreach or submit more frequent updates that can include monthly reporting. Plans can be subject to financial penalties if found uncompliant.