October Education Events by CAQH CORE

CAQH CORE October Education Events CAQH CORE October Town Hall National Webinar Thursday, October 22, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Join us for our quarterly Town Hall Call, a 60-minute interactive session, for the latest information on CAQH CORE activities, including:   The New Phase IV CAQH CORE Operating Rules: What's Next? Just approved by CORE vote! Get the first update on the new operating rules for claims, enrollment/disenrollment in a health plan, premium payments and prior authorizations, potential HHS action on Phase IV and soon to-be-released CORE FAQs, Planning and Analysis Guide and other implementation tools to help your Phase IV implementation go smoothly.    ACA-Mandated Health Plan Certification and Voluntary CORE Certification Update: With the statutory compliance date looming ahead, learn about the ACA-mandated health plan certification and, as we surpass the 200 CORE Certifications milestone, hear about current trends and why voluntary CORE Certification continues to grow in popularity.   Ongoing Maintenance of EFT/ERA - Get Involved! CORE is responsible for ongoing updates to the mandated Operating Rules: the EFT/ERA enrollment data set and the CAQH CORE Code Combination Maintenance Processes and Market-based Review. Your organization should get engaged in these efforts and have direct input into these revisions. Use the Code Combinations NOW to improve your claim adjustments and denials, and ensure they reflect industry usage and YOUR business needs. Hear how you can join these efforts, and how to report out your results.   CORE Future Focus: What are the opportunities being discussed by the CAQH CORE Board? Hear how they are considering where CORE can add the most value as the market moves from fee-for-service to value-based purchasing, and as we learn best practices from implementing some of the initial sets of ACA-driven operating rules.    Best practices in action! Mark your calendars for upcoming CAQH CORE webinar topics, including sessions on multi-phase CORE Certification, and how to improve your payment-remittance transactions.   Q&A: Bring your questions and share information about your experiences and benefits from your use of CORE Operating Rules, the CARC & RARC Code Combinations, and /or the CORE Certification process.   CAQH CORE Town Hall Calls provide the public with an update on CORE's recent activities related to industry development and/or implementation of Federally mandated operating rules. This call is open to all non-CORE and CORE Participants and is for informational purposes only; no voting or decisions will occur. _____________________________________________________________ Triple Play: Pursuing Voluntary CORE Certification Phases I through III Simultaneously Featuring: Group Health Cooperative Tuesday, October 27, 2015 | 2:00 - 3:00 pm ET Register HERE. Event is free.   Register for this webinar to learn about voluntary CORE Certification, one of the documents of compliance in the proposed rule for the ACA-mandated HHS health plan certification. Get an insider look at the experience of a recent CORE-certified entity, Group Health Cooperative, a member-governed, nonprofit health care system that coordinates care and coverage for more than 600,000 residents of Washington and North Idaho.Group Health Cooperative chose to pursue Phase I, II, & III CORE Certification concurrently, and they will discuss their approach to, and the benefits and challenges of, pursuing CORE Certification for all three phases at the same time. Get helpful advice from CAQH CORE-authorized Testing Vendor EDIFECS who will share tips to ensure the CORE Certification testing process goes smoothly, whether you work on one or multiple certifications.   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 Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

Updated Version of CORE Code Combinations Available for Implementation

Updated Version Now Available: October 2015 CORE Code Combinations v3.2.1 - Includes Adjustments for the Latest Compliance-based Review  The October 2015 updated version of the CORE-required Code Combinations for the CORE-defined Business Scenarios (CORE Code Combinations) is now available for use with the CAQH CORE 360: Uniform Use of CARCs and RARCs Rule. This version includes Compliance-based Adjustments as a result of code list updates published on July 1, 2015.   The CAQH CORE 360 Rule enables more uniform use of the Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) by focusing on a minimum set of common or problematic Business Scenarios, along with a maximum specified set of code combinations for each of these Scenarios. Per CAQH CORE policy, the CORE Code Combinations must be updated by the CAQH CORE Code Combinations Task Group to both: Align with the current published CARC and RARC lists which are maintained by code committees and updated at least three times per year. (Compliance-based Reviews); and Address ongoing and evolving industry business needs on an annual basis. (Market-based Reviews). A marked-up version of the October 2015 CORE Code Combinations showing the adjustments between v.3.2.0 and v.3.2.1 is available HERE. The Change Log in the second tab of the CORE Code Combinations provides a list of all adjustments made to the CORE Code Combinations.    For more information visit the Ongoing Maintenance of the CORE Code Combinations for CAQH CORE 360 Rule Webpage, a "one stop shop" for all the tools and information you need to comply with the CAQH CORE 360 Rule and the ongoing code combinations maintenance process. This website page includes both update summaries and links to more details.   In Q4 2015, the CAQH CORE Code Combinations Task Group will launch its next Compliance-based Review to review updates from the code list authors that are scheduled for publication in November 2015. The Task Group will also launch its Market-based Review of the potential new CORE-defined Business Scenarios submitted via the Industry-wide CAQH CORE 2014 Market-based Adjustments Form.   CAQH CORE Participants are encouraged to get involved with the Task Group. Contact core@caqh.org for information on joining the Task Group or becoming a CAQH CORE Participating Organization.   Please contact core@caqh.org with any additional questions.

TODAY: Benefits of Going Paperless in EFT/ERA Transactions for Hospitals & Providers - Webinar

REMINDER CAQH CORE and NACHA Joint National Webinar with  Midwest Center for Women's Healthcare and Hospital Corporation of America, Inc. TODAY THURSDAY, SEPTEMBER 10, 2015  2:00 - 3:00 PM ET REGISTER NOW There is no fee to attend. The Benefits of Going Paperless in Your EFT/ERA Transactions for Hospitals and Providers - A Multi-Provider Practice and a  Large Hospital Group Share Their Experiences Come join our partners from NACHA - The Electronic Payments Association - as we talk about the benefits of going paperless in your healthcare financial transactions. CAQH CORE will describe how federally-mandated Operating Rules require health plans to support a provider's ability to streamline their payment posting. NACHA will give an overview of the ACH Network and the 2015 Healthcare Electronic Funds Transfer (EFT) Volumes, as well as the Healthcare EFT Standard which leads to proven efficiencies and savings. We will also have two case studies on the time-saving benefits of switching from paper checks and explanation of benefits to the healthcare EFT and Electronic Remittance Advice (ERA). The case studies will feature the experiences of finance/billing professionals from both a mid-sized provider and a large hospital group. Our case study speakers will be Eric Brodsky, Director of Billing and Operations of the Midwest Center for Women's HealthCare in the suburban Chicago area, as well as Doug Downey, Vice President, Treasury Services, HCA, Inc. in Nashville, TN. Who Should Attend? This webinar is designed for all health care entities that can benefit from use of electronic transactions: hospitals, providers, health plans, vendors and clearinghouses. Departments that would find it useful include: Finance/Billing, Compliance, IT Claim Operations and Process Improvement. If you have questions, please contact CORE@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 Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

Benefits of Going Paperless in EFT/ERA Transactions for Small & Rural Hospitals - Webinar 9/10

CAQH CORE & NACHA Joint National Webinar with  Midwest Center for Women's Healthcare and Hospital Corporation of America, Inc. THURSDAY, SEPTEMBER 10, 2015  2:00 - 3:00 PM ET REGISTER NOW There is no fee to attend. The Benefits of Going Paperless in Your EFT/ERA Transactions for Small & Rural Hospitals - A Multi-Provider Practice & a Large Hospital Group Share Their Experiences Come join our partners from NACHA - The Electronic Payments Association - as we talk about the benefits of going paperless in your healthcare financial transactions. CAQH CORE will describe how federally-mandated Operating Rules require health plans to support a provider's ability to streamline their payment posting. NACHA will give an overview of the ACH Network and the 2015 Healthcare Electronic Funds Transfer (EFT) Volumes, as well as the Healthcare EFT Standard which leads to proven efficiencies and savings. We will also have two case studies on the time-saving benefits of switching from paper checks and explanation of benefits to the healthcare EFT and Electronic Remittance Advice (ERA). The case studies will feature the experiences of finance/billing professionals from both a mid-sized provider and a large hospital group. Our case study speakers will be Eric Brodsky, Director of Billing and Operations of the Midwest Center for Women's HealthCare in the suburban Chicago area, as well as Doug Downey, Vice President, Treasury Services, HCA, Inc. in Nashville, TN. Who Should Attend? This webinar is designed for all health care entities that can benefit from use of electronic transactions: hospitals, providers, health plans, vendors and clearinghouses. Departments that would find it useful include: Finance/Billing, Compliance, IT Claim Operations and Process Improvement. If you have questions, please contact CORE@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 Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

CAQH CORE & NACHA Joint National Webinar - September 10

CAQH CORE & NACHA Joint National Webinar with  Midwest Center for Women's Healthcare and Hospital Corporation of America, Inc. THURSDAY, SEPTEMBER 10, 2015  2:00 - 3:00 PM ET REGISTER NOW There is no fee to attend. The Benefits of Going Paperless in Your EFT/ERA Transactions for Small & Rural Hospitals - A Multi-Provider Practice & a Large Hospital Group Share Their Experiences Come join our partners from NACHA - The Electronic Payments Association - as we talk about the benefits of going paperless in your healthcare financial transactions. CAQH CORE will describe how federally-mandated Operating Rules require health plans to support a provider's ability to streamline their payment posting. NACHA will give an overview of the ACH Network and the 2015 Healthcare Electronic Funds Transfer (EFT) Volumes, as well as the Healthcare EFT Standard which leads to proven efficiencies and savings. We will also have two case studies on the time-saving benefits of switching from paper checks and explanation of benefits to the healthcare EFT and Electronic Remittance Advice (ERA). The case studies will feature the experiences of finance/billing professionals from both a mid-sized provider and a large hospital group. Our case study speakers will be Eric Brodsky, Director of Billing and Operations of the Midwest Center for Women's HealthCare in the suburban Chicago area, as well as Doug Downey, Vice President, Treasury Services, HCA, Inc. in Nashville, TN. Who Should Attend? This webinar is designed for all health care entities that can benefit from use of electronic transactions: hospitals, providers, health plans, vendors and clearinghouses. Departments that would find it useful include: Finance/Billing, Compliance, IT Claim Operations and Process Improvement. If you have questions, please contact CORE@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 Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.

CAQH Catalyst Newsletter - August 2015

August 2015

Rebranding and Website Launch CAQH has launched a redesigned website developed to communicate more effectively and improve the visitor experience. In addition to featuring refreshed branding that represents the mission and vision of the organization, www.CAQH.org now has a new structure that makes information easier to find. As the scope of CAQH activities expands beyond simplifying administrative processes to focus more broadly on "streamlining the business of healthcare", the redesigned website more comprehensively profiles the work of the organization. Continue reading...

The Value & Impact of Collaboration:  CAQH Presentation at AHIP Institute 2015  "Collaborating to Take Costs Out of the Business of Healthcare" Collaborative projects are advancing operational efficiencies, improving health plan and provider relations and reducing millions in costs for the healthcare system at large, according to examples recently provided by senior executives from three national health plans at AHIP Institute 2015. The presentation by CAQH explored the advantages of using industry-wide collaboration to improve routine business processes. In the session, titled "Collaborating to Take Costs Out of the Business of Healthcare," panelists explained how this approach helps ease the burden on individual health plans and provider organizations, while reducing unnecessary administrative costs. Continue reading...

CAQH CORE Testifies Before HHS Review Committee on Benefits/Challenges of Operating Rules At the inaugural hearing of the Affordable Care Act (ACA)-mandated Review Committee in June, CAQH CORE presented compelling testimony that operating rules have resulted in significant contributions to the business needs of the healthcare industry. CAQH CORE also emphasized that many opportunities still exist to use operating rules to achieve interoperable data exchange. Continue reading...

Other News

New CAQH Staff CAQH has welcomed the following new staff in 2015: Abrielle Anderson Counsel Erin Gibson Major Account Manager Jyoti "JJ" Jalali Senior Manager, Business Development Carl Johnson, Jr. Major Account Manager Sarah Kana Communications Associate Jessica Porras CAQH CORE Senior Manager for Education and Outreach Jack Unverferth Director of Technology Drew Voytal CAQH CORE Senior Project Associate for Education and Outreach   Continue reading...

CAQH CORE & NACHA JOINT NATIONAL WEBINAR Thursday, September 10, 2015 | 2:00 - 3:00 PM ET Join CAQH CORE and NACHA, along with Midwest Center for Women's Healthcare and Hospital Corporation of America, Inc., for a national webinar: "The Benefits of Going Paperless in Your EFT/ERA Transactions for Small & Rural Hospitals - A Multi-Provider Practice & a Large Hospital Group Share Their Experiences". Register or Learn More

CAQH In the News AHA Advisory Group Issues Report on Interoperability  Technology to Streamline Physician Credentialing 26 Recipients of Becker's Healthcare 2015 Leadership Awards  Orbograph Releases White Paper, "Strategic Considerations For Paper-based Healthcare Payments" AHIP: Payers team up to reduce administrative waste At AHIP Institute, collaboration is the name of the game Payer perspective: 7 key points on healthcare payments Cut costs, boost efficiency with the healthcare EFT standard

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National Webinar: EFT/ERA CAQH CORE Certification - Is it right for your organization?

Voluntary EFT/ERA CAQH CORE Certification National Webinar with MaineCare and PNC Healthcare TUESDAY, AUGUST 11, 2015  2:00 - 3:00 PM ET REGISTER NOW There is no fee to attend. "Is EFT/ERA CAQH CORE Certification right for your type of organization?" Why should a State Medicaid Agency become CAQH CORE-certified? Why would a clearinghouse seek CAQH CORE Certification? The fact is that CAQH CORE Certification benefits a multitude of stakeholder types. Join us on August 11th to learn more and get an insider look at the experiences of these recent CORE-certified entities. And get helpful tips from CAQH CORE-authorized Testing Vendor EDIFECS who will perform a live demo of their test site. What will you learn? Experience of MaineCare and PNC Healthcare in completing their recent CAQH CORE Certification process, including their best practices and lessons learned, and resulting benefits to their EFT/ERA transaction systems. How to navigate the complexities of trading partner coordination and trading partner role identification for maximum testing and certification success. What interfacing with the live CAQH CORE-authorized testing site means and tips ensuring that the CAQH CORE Certification testing process goes smoothly. Who Should Attend? All entities interested in voluntary CAQH CORE Certification are welcome to attend this educational webinar, especially those interested in EFT/ERA. If you have questions, please contact CORE@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 Department of Health and Human Services (HHS) as an author for ACA-mandated operating rules. To learn more about CAQH CORE, visit www.caqh.org.