Tuesday, April 05, 2016

#PDWorkshop – CAQH

CAQH is a not for profit that targets specific business problems to streamline the business of healthcare

CAQH DirectAssure is their Provider Directory Accuracy Initiative

CAQH ProView – Eases burden of provider data collection

Provider Data – Working Definition

  • People
  • Institutions
  • Locations
  • Relationships

Segment data

  1. Core (eg. NPI, Tax ID )
  2. Important (eg. Licensure)
  3. Additional

Value Chain

  • Provider Engagement (Collect)
  • Data Analytics (Evaluate and Feedback)
  • Information Management (Refinement and Relevance)
  • Information Consumption (Access)

Need to understand what data is important and how it is measured.

The Same data element may have different meanings based on the perspective of who is viewing (Certification Board, Payer, Consumer etc.)

The Pain points are changing and becoming more acute as new payment models are adopted. eg. Value Based Care.

Regulatory Complexities are further magnifying the pain points.

CAQH has industry-wide collaborations in place.

CAQH Proview

  • Multi-payer portal.
  • 1.3M Provider Users
  • 800 participating health plans, hospitals etc.
  • 12 states and DC have adopted.
  • Providers are asked the same information and used across all health plans etc.

DirectAssure is built on Proview
VeriFide goes live at end of 2016 and addresses a three step credentialling process that builds on ProView.

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