In becoming certified, these providers, health plans, government entities, clearinghouses and vendors have demonstrated their commitment to automation, interoperability and efficient business processes.
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8 Key Areas Representing $13.3B in Cost Saving Opportunities for Healthcare Administration
by Scott Overholt, Director of Business Development, Vyne Medical
Scott Overholt, Director of Business Development, Vyne Medical
According to the 2020 CAQH Index report, an annual report published by the Council for Affordable Quality Healthcare, a study of eight key transactional areas revealed opportunities for cost savings totaling $13.3 billion for medical providers and plans willing to move to fully electronic administrative processes. The CAQH report examined eight key transactions: Eligibility and Benefit Verification, Prior Authorization, Claim Submission, Attachments, Coordination of Benefits, Claim Status Inquiry, Claim Payment, and Remittance Advice.
1. Eligibility and benefit verification
With new Centers for Medicare and Medicaid Services regulations impacting information sharing for health plans going into effect this year and next, the Council for Affordable Quality Healthcare recently unveiled its CAQH Endpoint Directory to help payers with compliance.
WHY IT MATTERS
The CAQH Endpoint Directory was developed, with support from IT vendor Edifecs, as a one-stop shop for validated payer FHIR endpoints and third-party applications.
To build it, CAQH convened a work group of member health plans to gather feedback about their needs and capabilities, and drew on technology expertise at connectathons and other IT industry events.
The nonprofit also worked alongside the FHIR at Scale Task Force launched by the Office of the National Coordinator for Health Information Technology. And it collaborated with interoperability groups such as HL7 Da Vinci Project and CARIN Alliance.