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Industry Research
The CAQH Insights team releases issue briefs outlining their work and research. Explore the issue briefs and reports below to learn about cost saving opportunities for the healthcare industry and more.
| Implementing FHIR Technology: A Provider Perspective This issue brief details the challenges providers face in improving interoperability and adopting FHIR. |
| Increasing Transparency of Healthcare Charges: It’s a Manual Process This issue brief examines how GFEs are generated and communicated and opportunity areas to reduce provider burden. |
| Delegated Management Vendors and the Automation Opportunity This issue brief explores how plans and providers interact with delegated management vendors (DMVs) and identifies opportunities to improve how information is exchanged. |
| How Health Plans Connect: Payer-to-Payer Data Sharing This issue brief outlines health plans’ strategies and considerations for interoperability and the use of FHIR APIs to exchange data. |
| This issue brief, published in June 2022, outlines challenges faced by health plans and providers when exchanging clinical and administrative attachments for prior authorizations and claims. |
| Accelerating Interoperability and Patient Access This issue brief explores the healthcare industry's efforts towards meeting the goals of the 2020 CMS Interoperability Rule. |
| Communicating Attribution: Accessibility of Information to Support Value-based Payment Initiatives Published in November 2021, this issue brief outlines how patient attribution is exchanged and the challenges providers face related to attribution.
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| Healthcare Utilization During a Pandemic: How COVID-19 Impacted Administrative Transactions COVID-19 affected every level of healthcare. This issue brief, published in Spring 2021, explores the impact the pandemic had on healthcare utilization and administrative transactions. |
| Published in 2020, the 2019 CAQH Pharmacy Service Index tracks the adoption of electronic transactions associated with verifying insurance coverage for pharmaceuticals and related services, obtaining authorization for care, submitting a claim, and sending and receiving payments. |
| Many health plans and providers use a multiplicity of platforms to communicate with one another. This report explores the fragmented credentialing system, the opportunities for cost savings, and a better credentialing process for providers. |
| Engaging with HL7 FHIR: Health Plan Baseline Readiness and Challenges In the Spring of 2020, the Centers for Medicare & Medicaid (CMS) released Final Rules supporting industry interoperability and patient information access. This issue brief explores medical plans' readiness and barriers to HL7 FHIR implementation. |
| The Hidden Causes of Inaccurate Provider Directories A CAQH survey of 1,240 physician practices, conducted in September 2019, determined that directory maintenance costs practices nationwide $2.76 billion annually. Read the whitepaper to learn about this problem and how health plans and providers can work together to decrease the burden of directory updates. |
