CAQH CORE has released a new white paper on automating prior authorization. The paper identifies six barriers to automation:

The National Committee for Quality Assurance (NCQA) recently completed a review of CAQH ProView, DirectAssure, and CAQH ProView for Groups. In a letter to CAQH, NCQA states, “In addition to increasing efficiency in credentialing and network operations, these solutions are beneficial to NCQA customers in supporting accreditation.”

Texas is the latest state where leading health plans are adopting CAQH ProView to improve the accuracy of provider data. Participating organizations include Amerigroup, Superior HealthPlan and UnitedHealthcare, whose combined membership represents nearly 4 million Texans and more than 50 percent of the Medicaid covered population.

Today, 88 percent of prior authorizations are conducted either partially or entirely manually. CAQH CORE has released the Phase V Operating Rules to strengthen the accuracy and trustworthiness of the prior authorization process and move the industry toward full automation.

The healthcare industry has made significant progress in adopting electronic transactions for common business practices. However, the lack of a standard for attachments has contributed to cumbersome processes for exchanging patient-specific medical information and supplemental documentation.

CAQH continues to make progress in improving provider directory data. Most recently, CAQH launched a new portal that streamlines access to provider directory data by integrating DirectAssure and CAQH ProView.

Late last year, CAQH launched CAQH ProView for Groups to simplify the way data is shared between delegated provider groups and health plans. This first-of-its-kind functionality replaces the highly manual processes widely used today with an intuitive, efficient module within CAQH ProView.

Artificial Intelligence developed by CAQH is now making it possible to increase the accuracy of healthcare provider directories, without contacting the provider.

In a recent milestone for the healthcare system, industry-leading providers, Medicaid programs, health plans, clearinghouses, and product vendors have achieved more than 350 CORE Certifications. Each certification demonstrates a healthcare organization’s commitment to ensuring business transactions flow seamlessly.

CAQH recently submitted a [[{"fid":"6924","view_mode":"default","fields":{"format":"default","field_file_image_alt_text[und][0][value]":"CAQH Letter to Senate Committee","field_file_image_title_text[und][0][value]":"letter","field_folder[und]":"113","field_binary_asset_section[und]":"118","field_public[und]":"1","field_file_description[und][0][value]":"","field_file_description[und][0][format]":"full_html"},"type":"media","link_text":"letter","prev_link_text":"letter","attributes":{"class":"file media-element file-default"}}]] to the Senate Committee on Health, Education, Labor and Pensions