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- CAQH abstract "CAQH [legal name: Council for Affordable Quality Healthcare] is an American non-profit organization established in 2000 and based in Washington, DC. Its mission is to accelerate the transformation of business processes in healthcare through collaboration, innovation and a commitment to ensuring value across stakeholders, including healthcare providers, trade associations, and health plans.CAQH has created a number of initiatives to streamline the business of healthcare: CAQH CORE®, CAQH Solutions™ and CAQH Explorations™. CAQH Solutions include CAQH ProView™, SanctionsTrack®, EnrollHub® and COB Smart®. CAQH Explorations™, the research arm of CAQH, includes the CAQH Index®.CAQH COREEstablished in 2005, CAQH CORE (the Committee on Operating Rules for Information Exchange) is a multi-stakeholder collaboration of more than 140 organizations – providers, health plans, vendors, government agencies and standard-setting bodies – committed to the development and adoption of national operating rules for administrative transactions within the healthcare industry. CAQH CORE participating organizations include health plans representing more than 75% of commercially insured lives, plus Medicare and Medicaid beneficiaries.The Affordable Care Act (ACA) mandated better standardization of the electronic HIPAA administrative and financial transactions between providers and insurers. In 2012, CAQH CORE was designated by the Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. Operating rules support a range of existing standards to make electronic data transactions more predictable and consistent, regardless of technology used.The CAQH CORE process centers on an integrated model consisting of rule development, testing and certification, outreach and tracking measures. In 2012-2013, the organization released operating rules for four transactions now federally mandated for all HIPAA-covered entities: eligibility, claim status, electronic funds transfer and remittance advice (EFT/ERA). In 2015, it announced additional voluntary operating rules for healthcare claims, prior authorization, employee premium payment and employee enrollment and disenrollment.To drive and track market adoption, CAQH CORE offers a voluntary certification program so organizations can demonstrate that they have adopted and are adhering to the operating rules. Organizations that create, use or transmit administrative healthcare data (such as health plans, healthcare providers and vendors) can earn CORE Certification. In a January 2014 proposed rule, HHS recommended CAQH CORE as the administrator for HHS-required certification of health plans.CAQH SolutionsCAQH has developed several collaborative Solutions to address the need of the healthcare industry to reduce business costs and inefficiencies.Launched in 2002 and formerly known as the Universal Provider Datasource®, CAQH ProView is used by more than 1.3 million healthcare providers to self-report professional and demographic information. Health plans, hospitals and provider groups may utilize this information for provider credentialing, network directories and claims payments. Use of CAQH ProView reduces time and resources needed for these processes; it can also minimize manual error and reduce duplicative paperwork and administrative costs.SanctionsTrack, an add-on feature to CAQH ProView, is an automated, continuous sanctions monitoring solution that reviews multi-state information on provider licensure disciplinary actions. SanctionsTrack helps organizations eliminate redundant data gathering and follow-up research for sanction notices.Increasing adoption of electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollment continues to challenge healthcare organizations. To simplify this process, CAQH launched EnrollHub in 2013 to offer providers a single enrollment process for EFT and ERA with multiple payers. Providers complete the standardized, electronic enrollment form and select the health plans with which they do business. CAQH notifies the health plans of the enrollment, and the health plan then accesses the provider’s banking information.Used by health plans and clearinghouses, COB Smart helps identify instances of patients with overlapping insurance coverage. This CAQH Solution determines which individuals have benefits that should be coordinated, as well as which health plans are primary and secondary insurers, so that corresponding claims can be processed correctly the first time. COB Smart launched in 2014.CAQH ExplorationsCAQH Explorations is the research arm of the CAQH. It includes the CAQH Index, which tracks and reports progress by the healthcare industry in its ongoing transition from manual to electronic administrative transactions. The findings of the CAQH Index are based on an analysis of an extensive dataset of administrative transactions between providers and health plans. The 2014 CAQH Index reported that providers and health plans could potentially save $8 billion if they fully adopted electronic transactions.CAQH MembershipMembers include Aetna, Anthem, America’s Health Insurance Plans, AultCare, the BlueCross BlueShield Association, Blue Cross Blue Shield of Michigan, BlueCross BlueShield of North Carolina, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Cigna, Health Net, Horizon Blue Cross Blue Shield of New Jersey, Kaiser Permanente, and UnitedHealth Group.".
- CAQH locationCity Washington,_D.C..
- CAQH locationCountry United_States.
- CAQH wikiPageExternalLink www.caqh.org.
- CAQH wikiPageExternalLink 2015-06-08.
- CAQH wikiPageExternalLink 302129847.
- CAQH wikiPageExternalLink COB_Smart.htm.
- CAQH wikiPageExternalLink how-electronic-transactions-could-save-healthcare-8b-6-areas-of-opportunity.html.
- CAQH wikiPageExternalLink study-switch-from-manual-to-electronic-transactions-could-save-healthcare-8b.html.
- CAQH wikiPageExternalLink How-to-Identify-Who-Sent-Your-Healthcare-EFT-Payment-49889-1.html.
- CAQH wikiPageExternalLink debunking-myths-about-healthcare-EFT-51114-1.html.
- CAQH wikiPageExternalLink 1113350.
- CAQH wikiPageExternalLink aetna-to-insist-on-core-standards-certification.
- CAQH wikiPageExternalLink service-aims-to-end-health-coverage-conflicts.
- CAQH wikiPageExternalLink caqh-electronic-transactions-could-save-healthcare-billions.
- CAQH wikiPageExternalLink healthcare-eft-ach-volume-exceeds-149-million-transactions-2014.
- CAQH wikiPageID "21737072".
- CAQH wikiPageLength "13509".
- CAQH wikiPageOutDegree "31".
- CAQH wikiPageRevisionID "704986045".
- CAQH wikiPageWikiLink Aetna.
- CAQH wikiPageWikiLink Americas_Health_Insurance_Plans.
- CAQH wikiPageWikiLink Anthem_Inc..
- CAQH wikiPageWikiLink Aultman_Hospital.
- CAQH wikiPageWikiLink BlueCross_BlueShield_of_Tennessee.
- CAQH wikiPageWikiLink Blue_Cross_Blue_Shield_Association.
- CAQH wikiPageWikiLink Category:Non-profit_organizations_based_in_Washington,_D.C..
- CAQH wikiPageWikiLink Cigna.
- CAQH wikiPageWikiLink Credentialing.
- CAQH wikiPageWikiLink Electronic_funds_transfer.
- CAQH wikiPageWikiLink Electronic_remittance_advice.
- CAQH wikiPageWikiLink File:Organization_Logo_for_Center_for_Affordable_Quality_Healthcare_CAQH.jpg.
- CAQH wikiPageWikiLink Health_Insurance_Portability_and_Accountability_Act.
- CAQH wikiPageWikiLink Health_Net.
- CAQH wikiPageWikiLink Health_insurance.
- CAQH wikiPageWikiLink Health_professional.
- CAQH wikiPageWikiLink Horizon_Blue_Cross_Blue_Shield_of_New_Jersey.
- CAQH wikiPageWikiLink Kaiser_Permanente.
- CAQH wikiPageWikiLink Medicaid.
- CAQH wikiPageWikiLink Medicare_(United_States).
- CAQH wikiPageWikiLink Patient_Protection_and_Affordable_Care_Act.
- CAQH wikiPageWikiLink Trade_association.
- CAQH wikiPageWikiLink UnitedHealth_Group.
- CAQH wikiPageWikiLink United_States.
- CAQH wikiPageWikiLink United_States_Department_of_Health_and_Human_Services.
- CAQH wikiPageWikiLink Washington,_D.C..
- CAQH wikiPageWikiLinkText "CAQH".
- CAQH caption "Streamlining the business of healthcare.".
- CAQH divisions "CAQH CORE, CAQH Solutions, CAQH Explorations".
- CAQH homepage www.caqh.org.
- CAQH industry "Health Care, Information Technology".
- CAQH locationCity Washington,_D.C..
- CAQH locationCountry United_States.
- CAQH logo File:Organization_Logo_for_Center_for_Affordable_Quality_Healthcare_CAQH.jpg.
- CAQH name "CAQH".
- CAQH wikiPageUsesTemplate Template:Advert.
- CAQH wikiPageUsesTemplate Template:Infobox_company.
- CAQH wikiPageUsesTemplate Template:Multiple_issues.
- CAQH wikiPageUsesTemplate Template:Notability.
- CAQH wikiPageUsesTemplate Template:Refimprove.
- CAQH wikiPageUsesTemplate Template:Reflist.
- CAQH subject Category:Non-profit_organizations_based_in_Washington,_D.C..
- CAQH hypernym Organization.
- CAQH type Agent.
- CAQH type Company.
- CAQH type Organisation.
- CAQH type Organization.
- CAQH type Organization.
- CAQH type Organization.
- CAQH type Agent.
- CAQH type SocialPerson.
- CAQH type Thing.
- CAQH type Q43229.
- CAQH comment "CAQH [legal name: Council for Affordable Quality Healthcare] is an American non-profit organization established in 2000 and based in Washington, DC.".
- CAQH label "CAQH".
- CAQH sameAs Q5008780.
- CAQH sameAs m.05mty53.
- CAQH sameAs Q5008780.
- CAQH wasDerivedFrom CAQH?oldid=704986045.
- CAQH homepage www.caqh.org.
- CAQH isPrimaryTopicOf CAQH.
- CAQH name "CAQH".