CAQH

Council for Affordable Quality Healthcare

Industry	Health Care
Headquarters	Washington, DC, United States
Divisions	UPD, CORE
Website	http://www.caqh.org

The Council for Affordable Quality Healthcare is a non-profit alliance of health plans and trade associations, working to simplify healthcare administration through industry collaboration on public-private initiatives. CAQH strives to be a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers.

Through two initiatives -- the Committee on Operating Rules for Information Exchange (CORE) and Universal Provider Datasource (UPD) -- CAQH aims to reduce administrative burden for providers and health plans. These solutions promote quality interactions between plans, providers and other stakeholders; reduce costs and frustrations associated with healthcare administration; facilitate administrative healthcare information exchange; and encourage administrative and clinical data integration.

Members

CAQH members work together to create and refine initiatives for streamlining healthcare administration. Aetna, 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, UnitedHealth Group and WellPoint are among the health plans and trade associations that contribute to CAQH solutions.

Being a CAQH Member

There are a few important things you need to know about becoming a member. First, You need to be invited. You can’t go on to CAQH and upload your information; you need to be invited by an insurance company who can generate you a CAQH number. Only then can you can go to CAQH, complete the application.

Once accepted, don’t forget your re-attestation. Four times a year you’ll receive an email from CAQH, asking for you to “Re-attest” to the information in your profile. Not doing this can cause major problems with your ability to accept insurance, as the insurance companies you are paneled with will know the lapse in CAQH. Re-attestation only takes a few minutes (if you can remember your provider number and password), so log in and get it taken care of.

CAQH Initiatives

A catalyst for positive change, CAQH members collectively develop and implement administrative solutions that produce meaningful, concrete benefits – for physicians, allied health professionals, their staffs, patients and plans.

Universal Provider Datasource (UPD)

The CAQH Universal Provider Datasource (UPD) is achieving its vision of simplified data collection by reducing paperwork and millions of dollars of annual administrative costs for more than 1 million providers and over 650 health plans and networks across the United States.

Launched in 2002, UPD allows registered physicians and other health professionals in all 50 states and the District of Columbia to enter their information free of charge into a single, uniform online application that meets the data needs of health plans, hospitals and other healthcare organizations. Approximately 7,000 new providers begin using the service each month. The provider data-collection service streamlines the initial application and re-credentialing processes, reduces provider administrative burdens and costs, and offers health plans and networks real-time access to reliable provider information for claims processing, quality assurance and member services, such as directories and referrals.

UPD is supported by the American Medical Association, the American Academy of Family Physicians, the American College of Physicians, the Medical Group Management Association, America’s Health Insurance Plans, the American Health Information Management Association, and other provider organizations. Indiana, Kansas, Kentucky, Louisiana, Maryland, Missouri, New Jersey, New Mexico, Ohio, Rhode Island, Tennessee, Vermont and the District of Columbia have adopted the CAQH Standard Provider Application as their mandated or designated provider credentialing form. The UPD form meets all related URAC, National Committee on Quality Assurance and the Joint Commission on Accreditation of Healthcare Operations standards.

The Ongoing Sanctions Monitoring Module, UPD’s add-on feature, is quickly identifying providers with sanctions and/or disciplinary actions through daily updates drawn from all state licensing boards, the Office of Inspector General, Office of Personnel Management and Medicare/Medicaid sources -- more than 480 in all.

Committee on Operating Rules for Information Exchange (CORE)

CAQH launched the Committee on Operating Rules for Information Exchange (CORE) with the vision of giving providers access to eligibility and benefits information before or at the time of service using the electronic system of their choice for any patient or health plan.

CORE is more than 130 industry stakeholders – health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and banking industry experts that maintain eligibility, benefits, and claims data for over 150 million commercially insured lives, plus the Medicaid eligibility processed by some of the plans and vendors, e.g. Unisys, and the Medicare beneficiaries. Working in collaboration, they are building consensus on a set of operating rules that will:  Enhance interoperability between providers and payers  Streamline eligibility, benefits, and claims data transactions  Reduce the amount of time and resources providers spend on administrative functions – time better spent with patients Operating rules build on existing standards to make electronic transactions more predictable and consistent, regardless of the technology. Rights and responsibilities of all parties, security, transmission standards and formats, response time standards, liabilities, exception processing, error resolution and more must be clearly defined in order to facilitate successful interoperability. Beyond reducing cost and administrative hassles, operating rules foster trust among all participants.

Simplified Prescribing

To make administrative systems and processes easier for providers, their office staffs and patients, CAQH joined with RxHub (currently Surescripts) to launch the nation's most inclusive electronic database of formulary information. The partnership combines formulary information from participating CAQH member health plans with that from RxHub's participating Pharmacy Benefit Managers (PBMs), creating a centralized formulary database that is available to interested technology vendors through the RxHub system. By working together, CAQH and RxHub have created a single source that provides formulary data for a majority of commercially insured Americans. This partnership is just one way in which CAQH is working to promote e-prescribing solutions to reduce administrative burdens for providers.

Save Antibiotic Strengthsm

Antibiotics are commonly thought of as wonder drugs, yet inappropriate use is diminishing the effectiveness of these lifesaving medicines. CAQH joined the fight to preserve the power of antibiotics. Save Antibiotic Strength is a national campaign to educate Americans about the importance of using antibiotics appropriately, and to provide physicians with the information and tools they need to deliver this message to their patients. Through the campaign, CAQH worked with the Centers for Disease Control and Prevention (CDC) and several state coalitions to help prevent the misuse of antibiotics.

heartBBEAT for life®

Each year, more than 400,000 Americans suffer a heart attack. However, many Americans ignore one of the easiest steps to preventing future heart attacks: taking a beta-blocker. In fact, long-term use of beta-blockers has been proven to reduce the risk of another heart attack and death by up to 40 percent. To raise awareness of the critical role of beta-blockers in preventing future heart attacks CAQH launched its national campaign, heartBBEAT for life, to educate patients, caregivers and healthcare providers about why the long-term use of these medications is so important. CAQH worked with the American Heart Association, American College of Cardiology, the American Academy of Family Physicians and the American College of Physicians to help spread the word and increase the long-term use of beta-blockers among heart attack survivors.

More than 980,000 providers in all 50 states and the District of Columbia and over 550 health plans, hospitals and other healthcare organizations currently use the service to streamline data-collection processes.

External links

• CAQH official website
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