CAQH Announces an Initiative with Leading Health Plans to Support Healthcare Providers and Improve Data Quality

The effort, outlined in a new issue brief, “Improving Provider Data Quality: A Collaborative Initiative,” focuses on ways collective action can address complex, costly problems related to payer-provider data-sharing that impacts the healthcare experience for all. 

CAQH today announced a new initiative developed in collaboration with many of the nation’s leading health plans. They have come together to take action to improve provider and member experiences by addressing provider abrasion and issues related to the exchange of data.

The issue brief, “Improving Provider Data Quality: A Collaborative Initiative,” was developed in partnership with national and regional health plans from across the country. It describes the effort, including insights on the root cause of the challenge, a set of principles guiding the development of tangible solutions, and initial steps to improve provider data quality on a practical scale. The goal is to deliver an adaptable and repeatable model for change across the industry.

“We are excited to be a part of this multi-payer initiative and are building the relationships and knowledge to drive necessary change, innovation, and ongoing improvements that allow us all to better meet the needs of our providers and members,” noted Amy Martinez, Assistant Vice President, Network Operations at Blue Cross NC.

Accurate information about providers, ranging from demographics to professional details to locations and affiliations, is essential to the reliable delivery of healthcare services. Yet information-sharing is both complex and burdensome to most providers. Efforts by health plans to work with providers individually have not proven scalable, given that most providers work with 20+ health plans.¹     

“After decades of investment in new technology and resources aimed at simplifying data exchange between payers and providers, the process is still cumbersome and costly,” said CAQH’s Chief Executive Officer, Sarah Ahmad. “Together with our health plan partners, we’re committed to making meaningful change.” 

The CAQH Index, the industry’s leading source for tracking the adoption of fully electronic administrative transactions and the opportunity for future savings, highlighted opportunities to reduce administrative burden for providers. Ahmad noted that “Provider shortages and burn-out are plaguing the industry. It’s critical that we collectively continue to look for solutions – in the form of new processes, technologies, and automation – that allow providers to spend more time with patients to deliver better care and a better experience.  We look forward to working with plans, providers, and other stakeholders to drive these improvements forward.”

To learn more about the provider data quality initiative, click here to read the issue brief. 

 ¹ “Improving Health Plan Provider Directories and the Need for Health Plan-Practice Alignment, Automation and Streamlined Workflows,” CAQH and the AMA, November 2019