Want to Improve Your Claims Denial Management Process?

Want to Improve Your Claims Denial  Management Process? Act Now - Survey Deadline is February 10, 2016. Calling all providers, medical office managers, and claims adjustment reviewers faced with costly claim denials and adjustments. If you are involved in the healthcare claim payment or remittance process and are facing costly manual claim denials and adjustments, submit a response NOW to the CAQH CORE Code Combinations Market-based Review Industry Survey. How to Participate   Submissions for potential Market-based Adjustments can be made via an easy-to-use online form. Depending on your amount of input, the survey can take as little as one hour to complete. The link to the submission form and a training webinar (advance to minute 19 for a live demonstration of the submission form) will point you in the right direction so you can be ready to submit before the deadline of February 10th.   Impact & Next Steps for the Market-based Review   Key benefits of the CORE Code Combinations include: Reduced unnecessary manual provider follow-up Decrease in faulty electronic secondary billing Fewer inappropriate write-offs of billable charges Improved billing of patients for co-pays and deductibles Reduction in posting delays  Submissions to the CAQH CORE Market-based Review Survey are reviewed by the CAQH CORE Code Combination Task Group to determine adjustments to the next update of the CORE Code Combinations. Your submission will lead to improvements that will save you time and money if you are struggling with inaccurate code combinations or if the code combinations are not meeting all your  business needs.   Due to recent Federal mandates, practices and facilities nationwide have experienced noticeable improvement with their claims denial management thanks to clearer and more consistent use of the claim denial and adjustment codes. If for some reason you are not experiencing these benefits, contact CORE@caqh.org.    Need more information? Visit the CORE Code Combinations website or contactCORE@caqh.org. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

Want to Improve Your Claim Denial and Management Process?

Want to Improve Your Claim Denial and  Management Process? Tell Us How by Submitting a Market-based Review by  February 10, 2016. Calling all providers, medical office managers, and claims adjustment reviewers faced with costly claims denials and adjustments. If you are involved in the healthcare claim payment or advice process (835 transaction), and are facing costly manual claims denials and adjustments, make your submission NOW to the CAQH CORE Code Combination Market-based Review to improve the use of the Claim Adjustment Remark Codes (CARC) and Remittance Advice Adjustment Remark Codes (RARC). The deadline for submission is February 10th so plan your submission NOW. Each year, CAQH CORE issues a call for its Market-based Review of the CORE Code Combinations found in the four CORE-defined Business Scenarios. Through the Market-based Review, healthcare stakeholders are able to add, remove or relocate CORE Code Combinations, to make day-to-day claims submissions  more efficient.   Other key impacts include: Reduced unnecessary manual provider follow-up Decrease in faulty electronic secondary billing Fewer inappropriate write-offs of billable charges Improved billing of patients for co-pays and deductibles Reduction in posting delays Need more information? Go to the CAQH CORE website to get the information you need to submit a Market-based Review.   Submissions can be made via an easy-to-use online form. Depending on how many changes you plan on submitting, it could take less than an hour for one submission or more if you have numerous changes to submit. The link to the submission formand a training webinar (advance to minute 19 for a live demonstration of the submission form) will point you in the right direction so you can be ready to submit before the deadline of February 10, 2016.   What happens next? The submissions are used by the CAQH CORE Code Combination Task Group to help determine changes that they will recommend for the next update of the CORE Code Combinations. Your submission will lead to improvements that will save you time and money down the line. Get ready. Act NOW! The deadline is February 10th. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

January Education Events by CAQH CORE

Upcoming CAQH CORE January Education Events New Phase IV CAQH CORE Operating Rules National Webinar Thursday, January 21, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. The Complete Set of Phase IV CAQH CORE Operating Rules was approved through the CAQH CORE voting process in September 2015. This webinar will give a high-level overview of Phase IV Rules and new resources and tools to support industry implementation of the new operating rules. This is an encore presentation of the December 10, 2015 webinar. ______________________________________________________________ Voluntary CORE Certification National Webinar with Alabama Medicaid Agency Tuesday, January 26, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. Why should a State Medicaid Agency pursue Voluntary CORE Certification? What are the unique challenges that Medicaid agencies face when undertaking the CORE Certification process? Get an insider look at the experience of a recent CORE-certified entity, Alabama Medicaid Agency, who has completed all three Voluntary CORE Certification Phases. Register now for this webinar to learn about CORE Certification and whether it is appropriate for your state Medicaid agency or similar state or Federal organization. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

January Education Events by CAQH CORE

Upcoming CAQH CORE January Education Events New Phase IV CAQH CORE Operating Rules National Webinar Thursday, January 21, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. The Complete Set of Phase IV CAQH CORE Operating Rules was approved through the CAQH CORE voting process in September 2015. This webinar will give a high-level overview of Phase IV Rules and new resources and tools to support industry implementation of the new operating rules. This is an encore presentation of the December 10, 2015 webinar. ______________________________________________________________ Voluntary CORE Certification National Webinar with Alabama Medicaid Agency Tuesday, January 26, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. Why should a State Medicaid Agency pursue Voluntary CORE Certification? What are the unique challenges that Medicaid agencies face when undertaking the CORE Certification process? Get an insider look at the experience of a recent CORE-certified entity, Alabama Medicaid Agency, who has completed all three Voluntary CORE Certification Phases. Register now for this webinar to learn about CORE Certification and whether it is appropriate for your state Medicaid agency or similar state or Federal organization. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

January Education Events by CAQH CORE

CAQH CORE January Education Events CAQH CORE January Town Hall National Webinar - Jumpstart 2016 Thursday, January 7, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free.   Learn about important industry highlights for 2016 and how they may affect your organization. CAQH CORE Town Hall Calls provide updates on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. Bring your questions about the CAQH CORE Operating Rules, the CARC & RARC Code Combinations, and the CORE Certification process. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. ______________________________________________________________ New Phase IV CAQH CORE Operating Rules National Webinar Thursday, January 21, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. The Complete Set of Phase IV CAQH CORE Operating Rules was approved through the CAQH CORE voting process in September 2015. This webinar will give a high-level overview of Phase IV Rules and new resources and tools to support industry implementation of the new operating rules. This is an encore presentation of the December 10, 2015 webinar. ______________________________________________________________ Voluntary CORE Certification National Webinar with Alabama Medicaid Agency Tuesday, January 26, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. Why should a State Medicaid Agency pursue Voluntary CORE Certification? What are the unique challenges that Medicaid agencies face when undertaking the CORE Certification process? Get an insider look at the experience of a recent CORE-certified entity, Alabama Medicaid Agency, who has completed all three Voluntary CORE Certification Phases. Register now for this webinar to learn about CORE Certification and whether it is appropriate for your state Medicaid agency or similar state or Federal organization. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

January Education Events by CAQH CORE

CAQH CORE January Education Events January Education Events CAQH CORE January Town Hall National Webinar - Jumpstart 2016 Thursday, January 7, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free.   Learn about important industry highlights for 2016 and how they may affect your organization. CAQH CORE Town Hall Calls provide updates on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. Bring your questions about the CAQH CORE Operating Rules, the CARC & RARC Code Combinations, and the CORE Certification process. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. ______________________________________________________________ New Phase IV CAQH CORE Operating Rules National Webinar Thursday, January 21, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. The Complete Set of Phase IV CAQH CORE Operating Rules was approved through the CAQH CORE voting process in September 2015. This webinar will give a high-level overview of Phase IV Rules and new resources and tools to support industry implementation of the new operating rules. This is an encore presentation of the December 10, 2015 webinar. ______________________________________________________________ Voluntary CORE Certification National Webinar with Alabama Medicaid Agency Tuesday, January 26, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. Why should a State Medicaid Agency pursue Voluntary CORE Certification? What are the unique challenges that Medicaid agencies face when undertaking the CORE Certification process? Get an insider look at the experience of a recent CORE-certified entity, Alabama Medicaid Agency, who has completed all three Voluntary CORE Certification Phases. Register now for this webinar to learn about CORE Certification and whether it is appropriate for your state Medicaid agency or similar state or Federal organization. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

CAQH CORE Announces Launch of 2015 Market-based Review for CORE Code Combinations

The CAQH® Committee on Operating Rules for Information Exchange (CORE®) today launched the industry-wide submission period for the 2015 Market-based Review (MBR) of the CORE-required Code Combinations for the CORE-defined Business Scenarios. Per the established CAQH CORE Code Combinations Maintenance Process, the CAQH CORE Code Combinations Task Group (CCTG) conducts two types of reviews and adjustments: Compliance-based Reviews and Market-based Reviews. Market-based Reviews occur once per year and enable the industry to make adjustments to the CORE Code Combinations to address ongoing and evolving business needs. 2015 MBR INDUSTRY-WIDE SUBMISSION PERIOD The 2015 MBR will consider adjustments to the existing four CORE-defined Business Scenarios. Potential adjustments that can be submitted include additions, removals, or relocations to code combinations in the existing CORE-defined Business Scenarios based on evaluation criteria, usage data, and a strong business case. DUE DATE: Responses to the 2015 MBR must be received by 5pm ET onWednesday, 02/10/16. WHO CAN SUBMIT: All CORE Participants, plus non-CORE Participants that create, use, or transmit HIPAA-covered transactions, may submit potential Market-based adjustments via the online CAQH CORE 2015 Market-based Adjustments Form.  GETTING STARTED: Eligible entities wishing to participate in the 2015 MBR can begin by completing Part 1 of the online form HERE.     ADDITIONAL RESOURCES: Detailed instructions to assist in the completion of the online 2015 Market-based Adjustments Form are available HERE. A sample completed CAQH CORE 2015 Market-based Adjustments Form is also available HERE for consultation as entities plan their submission.  Additionally, CAQH CORE education sessions will be offered announcing and explaining the MBR submission process.  NOTE: The CCTG is currently considering the 2014 industry submissions for potential new CORE-defined Business Scenarios. During its review of the 2014 new CORE-defined Business Scenario submissions, the CCTG will determine a later date to collect additional submissions for potential new CORE-defined Business Scenarios.   If you need additional assistance in navigating the Market-based Adjustments Form or have any questions regarding the 2015 MBR, please email core@caqh.org.

December and January Education Events by CAQH CORE

CAQH CORE December and January Education Events December Education Events New Phase IV CAQH CORE Operating Rules National Webinar Thursday, December 10, 2015 | 2:00 - 3:00 pm ET Register for this event HERE for free. The Complete Set of Phase IV CAQH CORE Operating Rules was approved through the CAQH CORE voting process in September 2015. This webinar will give a high-level overview of the voluntary Phase IV Rules for claims, enrollment/disenrollment in a health plan, premium payments and prior authorizations. CAQH CORE staff will also describe the process for developing and approving the operating rules, and highlight newly available planning and educational tools. ______________________________________________________________ Training Session on Annual Industry Opportunity to Make Changes to the CAQH CORE Code Combinations - the 2015 Market-based Review Wednesday, December 16, 2015 | 2:00 - 3:00 pm ET Register for this event HERE for free.   The CAQH CORE 360: Uniform Use of CARCs and RARCs Rule and the CORE Code Combinations provide uniformity in the use of claim payment adjustment/denial codes in defined universal business scenarios. The Market-based Review is the industry's annual opportunity to make adjustments to the CORE Code Combinations to address ongoing and evolving business needs. The 2015 CAQH CORE Market-based Adjustment Form (2015 MBR Form) submission period will begin in early December. This session will provide information regarding the 2015 CAQH CORE Market-based Review process, guidance on completing the online 2015 MBR Form, and a live demo of the online 2015 MBR Form. All CORE Participants plus non-CORE Participants that create, use, or transmit HIPAA-covered transactions may submit potential Market-based adjustments for consideration by the CAQH CORE Code Combinations Task Group (CCTG). ______________________________________________________________ January Education Events CAQH CORE January Town Hall National Webinar - Jumpstart 2016 Thursday, January 7, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free.   Learn about important industry highlights for 2016 and how they may affect your organization. CAQH CORE Town Hall Calls provide updates on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. Bring your questions about the CAQH CORE Operating Rules, the CARC & RARC Code Combinations, and the CORE Certification process. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. ______________________________________________________________ New Phase IV CAQH CORE Operating Rules National Webinar Thursday, January 21, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. The Complete Set of Phase IV CAQH CORE Operating Rules was approved through the CAQH CORE voting process in September 2015. This webinar will give a high-level overview of Phase IV Rules and new resources and tools to support industry implementation of the new operating rules. It will cover the same material as the December 10, 2015 webinar. ______________________________________________________________ Voluntary CORE Certification National Webinar with Alabama Medicaid Agency Tuesday, January 26, 2016 | 2:00 - 3:00 pm ET Register for this event HERE for free. Why should a State Medicaid Agency pursue Voluntary CORE Certification? What are the unique challenges that Medicaid agencies face when undertaking the CORE Certification process? Get an insider look at the experience of a recent CORE-certified entity, Alabama Medicaid Agency, who has completed all three Voluntary CORE Certification Phases. Register now for this webinar to learn about CORE Certification and whether it is appropriate for your state Medicaid agency or similar state or Federal organization. About CAQH CORE CAQH CORE is a national multi-stakeholder initiative that streamlines electronic healthcare administrative data exchange and improves health plan-provider interoperability through an integrated model of operating rule development, adoption and maintenance. CAQH CORE has been designated by the Secretary of the Department of Health and Human Services (HHS) as the author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.