Recently, representatives from health plans across the country convened in Washington DC for the third COB Smart Symposium. The event represents a rare opportunity for thought leaders to meet in person to share best practices and collaborate on strategies to improve the coordination of benefits (COB) process. Traditionally, COB is managed through manual, reactionary processes that often result in unnecessary administrative burdens, and lost revenue. However, plans are increasingly adopting automated processes that allow them to manage payments before a claim is submitted.

Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies, has joined other national health benefits companies in the effort to improve the accuracy of health care provider directories by participating in CAQH DirectAssure®.

CAQH CORE has voted to set two-day time limits on how quickly health plans must request additional supporting information from providers and make final determinations on prior authorization requests.

CAQH has released the seventh annual report measuring the progress made by the healthcare industry in reducing the costs and burden associated with administrative transactions through automation. The 2019 CAQH Index found that, of the $350 billion dollars widely cited as the cost of administrative complexity in the US healthcare system, $40.6 billion is spent on eight administrative transactions.

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 has resulted in a fragmented ecosystem that is impeding interoperability and administrative simplification.

Last year, CAQH implemented several enhancements to CAQH ProView, many of which were inspired by feedback we have received by users. Here are a few highlights:

Two of the nation’s largest healthcare organizations have earned Phase III CAQH CORE certification in recognition of their commitment to streamlining the electronic funds transfer (EFT) and electronic remittance advice (ERA) processes. Learn more about CAQH CORE Phase III rules.

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, determined that directory maintenance costs practices nationwide $2.76 billion annually. Updating directory information costs each practice $998.84 on average every month and requires the equivalent of one staff day per week.

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 solutions meet key healthcare regulations and requirements for protecting and securing sensitive private healthcare information. This achievement places CAQH in an elite group of organizations worldwide.