Podcasts about caqh

A modern digital healthcare economy is impossible without a robust provider directory, which serves as the foundation for interoperability and crucial processes.  In this episode, Erin Weber, Chief Policy and Research Officer, discusses how CAQH supports provider directories, emphasizing the need for data accuracy and standardization through initiatives like universal group roster templates. She highlights the importance of interoperability and maintaining accurate data to ensure seamless care delivery and billing. Don Rucker, Chief Strategy Officer, talks about modern FHIR APIs and interoperability. He uses the analogy of domain name services on the internet and stresses the need for “computable interoperability” where data can be used in real time to improve care. They explain how the 21st Century Cures Act has impacted healthcare and how legacy systems need to be modernized. Don and Erin stress that this work is crucial for modern healthcare to evolve and deliver improved patient experiences.  Tune in and learn how these key changes are shaping the future of healthcare! Resources: Connect with and follow Erin Weber on LinkedIn. Follow CAQH on LinkedIn and visit their website. Connect with and follow Don Rucker on LinkedIn. Learn more about 1upHealth on their LinkedIn and website. Check out the latest annual CAQH Index Report here.

In this episode of The Dish on Health IT, host Tony Schueth and payer interoperability expert Kendra Obrist sit down with Rob Alger, SVP of Health Plan Technology at Kaiser Permanente, for a candid and sweeping conversation about payer interoperability, AI, FHIR, and the realities of health IT innovation at scale.Rob kicks things off by discussing Kaiser Permanente's unique care and coverage model, highlighting how it streamlines internal coordination and shapes investment priorities. He notes that, unlike many other health plans, Kaiser's vertically integrated structure allows for fewer administrative hurdles, particularly in areas like prior authorization.The conversation then turns to CMS-0057. While Rob acknowledges Kaiser must comply like everyone else, the regulation presents less of a lift for them due to their internal alignment. That said, both he and Kendra agree: the success of any interoperability initiative hinges on provider adoption, and that remains uncertain.Looking ahead to 2025, Rob shares Kaiser's strategic focus on simplifying healthcare experiences, especially by leveraging AI to remove friction from both clinical and administrative processes. One standout example is their ambient listening tool from Abridge, now rolled out across 40 hospitals and 600 medical offices, which is allowing clinicians to focus more on patients than keyboards. It's one of the fastest clinical tech adoptions Rob's ever seen.Naturally, the discussion shifts to FHIR. Rob puts it plainly: “FHIR is non-negotiable.” Regulatory mandates have solidified its role, but he wonders whether the industry will eventually want to use FHIR or continue reacting to policy. Kendra and Tony weigh in, noting signs of growing pull once organizations recognize the potential. They agree that multi-stakeholder efforts like Da Vinci Project and FHIR at Scale Taskforce (FAST) are helping to build real-world traction by solving for shared use cases.When asked why Kaiser stays engaged in these initiatives, Rob makes it clear it's about shaping standards early, staying ahead of the curve, and making smarter, future-proof decisions, especially when it comes to vendor selection.The episode then revisits AI, with Rob outlining Kaiser's guiding principles: human in the loop, bias mitigation, and responsible governance. He explains that while Kaiser isn't trying to build every tool themselves, they aim to be excellent adopters, using AI to free up clinicians and call center reps to operate at the top of their license. It's less about chatbots and more about smarter workflows, ambient data capture, and preserving session context across modalities.Data quality surfaces as a recurring theme. Kendra highlights increasing payer interest in tackling inconsistency and fragmentation. Rob acknowledges Kaiser has an edge due to its standardized EHR system, but insists no one is immune to the challenges, especially when AI is in the mix. As he puts it, “If your data's not clean, you're not going anywhere.”As a member of the Council for Affordable Quality Healthcare (CAQH) board, Rob brings a unique perspective on industry-wide infrastructure and collaboration. He explains that CAQH, originally formed by major health plans to tackle non-competitive operational challenges, has evolved into a key player in both standards development and practical solutions like coordination of benefits and provider directories. That dual focus—advocacy and action—resonates throughout the conversation, especially as Rob underscores the importance of shared investments in foundational infrastructure that lift the entire industry.The discussion then touches more specifically on directories and the potential of shared infrastructure for non-competitive areas of healthcare. Rob emphasizes that while payers care deeply about directory accuracy, the solution likely involves more human accountability than tech alone.In closing, the trio shares their perspectives on under-discussed industry challenges. Rob flags cybersecurity as a growing threat, especially in light of recent ransomware attacks. Kendra and Tony shine a light on consent and pharmacy interoperability, two areas that, while not headline-grabbing, could unlock major gains in care coordination and equity.Rob's parting call to action? It's time for the industry to align on clinical policy. Competing on utilization rules isn't sustainable, and getting consensus on what's appropriate care could help streamline prior auth and improve patient trust.Kendra wraps by urging payers to suspend disbelief and start planning for a world where APIs and data exchange work as intended. Dream a little, and then build accordingly. 

In this special HIMSS25 recap episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by co-hosts Brian Bamberger, POCP's Life Sciences Lead, and Vanessa Candelora, Senior Consultant and Program Manager of the HL7 Gravity Project. Together, they break down the biggest themes from the conference, covering interoperability, artificial intelligence (AI), FHIR adoption, and the growing focus on improving data quality in healthcare innovation.HIMSS25 once again proved to be a crucial gathering of healthcare leaders, vendors, and policymakers, drawing nearly 28,000 attendees. Vanessa notes the continued focus on interoperability and trust, with a clear divide between experienced stakeholders refining their strategies and newcomers trying to grasp the fundamentals of FHIR. Brian, a HIMSS veteran, points out that first-time attendees often struggle with the complexity of both the conference itself and the discussions around health IT's latest advancements, particularly AI and its real-world applications.To add perspectives from the conference floor, Tony introduces a series of interviews with HIMSS25 attendees and industry leaders, including Anna Taylor, Associate Vice President, Population Health and Value-Based Care of MultiCare, Erin Weber, Chief Policy & Research Officer, CAQH, Mariann Yeager, CEO, The Sequoia Project, Matthew Holt, Founder/Writer of The Health Care Blog, and Lynne Nowak, Chief Data and Analytics Officer. Each interview provides insights into the real-world implementation of interoperability and FHIR, the evolving use of AI, and how data privacy and governance are shaping health IT strategy.FHIR adoption was one of the topics covered in the interviews. Some, like Mariann Yeager and Erin Weber, expressed optimism about FHIR's expanding role in clinical data exchange, while others, such as Anna Taylor, highlighted persistent scalability challenges and limited adoption for administrative functions like prior authorization. Matthew Holt offered a broader view on data exchange, arguing that while data mobility has improved, the real challenge is how organizations actually use and integrate that information. Vanessa underscores that while FHIR is gaining traction globally, large-scale implementation remains a work in progress. The panel agrees that translating theoretical frameworks into real-world adoption is the next crucial step.AI was another dominant topic, with a mix of enthusiasm and skepticism surrounding its potential. The HIMSS interviewees discuss AI's growing role in streamlining administrative workflows, summarizing patient records, and enabling ambient listening for clinical documentation. However, as Brian bluntly puts it, the “magic” of AI is still far from reality—many tools promise seamless EHR integration but lack the ability to write back into clinical systems, requiring manual intervention. Lynne Nowak and others emphasized that AI's effectiveness is directly tied to data quality—bad inputs will only lead to bad outputs. The consensus? AI has real potential to enhance workflows but cannot replace clinicians, and health IT leaders must focus on governance, usability, and ensuring AI supports, rather than replaces, human decision-making.As the conversation wraps up, Vanessa highlights the critical role of policy and strategic innovation in shaping the next wave of health IT progress. With new regulatory shifts and uncertainty around TEFCA, organizations must stay agile while ensuring that patient privacy, data integrity, and consent management remain top priorities. Brian brings the discussion back to life sciences, stressing the importance of leveraging patient insights and real-world data to drive treatment adherence and improve outcomes.HIMSS25 reinforced that while FHIR, AI, and interoperability remain hot topics, the industry is now at a critical inflection point—shifting from theory to execution. Organizations must filter out hype, focus on data quality, and build scalable solutions that improve both clinical and administrative functions.For those who couldn't attend HIMSS25 or want a deeper dive into what's next for health IT, this episode provides a comprehensive breakdown of the major takeaways. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or your preferred platform. The podcast is also available on HealthcareNOW Radio. Full video versions are also available on POCP's YouTube channel. As always, health IT is a dish best served hot. 

Join us for this Episode of Dental Unscripted with host Mike Dinsio, co-host Paula Quinn, and special guest Stefani Sandoval as they dive deep into the complex world of dental credentialing during practice acquisitions. Connect with Next Level Consultants Team to learn more about their Dental Credentaling Service‪CALL: (253) 234-5288‬ EMAIL: admin@nxlevelconsultants.comhttps://www.nxlevelconsultants.com/front-office-support.html0:00 Intro music 1:00  Episode intro Podcast AnnouncementsOur front office expert breaks down what every dentist needs to know about this crucial but often complex and frustrating process of getting credentialed We even discuss the differences between a practice ownership transition and simply moving from one practice to another as an associate.Common credentialing pitfalls to avoidEssential documentation you needThe truth about insurance company timelinesCritical differences between associate and owner credentialing3:00 The Credentialing ProcessWhen purchasing a dental practice, understanding both your current credentialing status and the seller's network participation is crucial. Credentials and reimbursements can vary per location so it can be insightful and strategic to mirror what the seller's existing insurance arrangements for a smoother transition.6:00 How to Prepare to Get Credentialed Getting accurate credentialing information during a practice transition can be challenging since brokers don't handle these details. Moreover, sellers are often unfamiliar with their own status. Front office team members manage this information and sellers may not request this information for fear of revealing a pending sale?! To verify individual doctor's credentialing status, dentists should proactively maintain copies of their insurance contracts. Direct contact with insurance networks to verify, and, when possible, inquire with front office staff about existing credentialing contracts. 14:50 Common Roadblocks and ChallengesCommon delays in the credentialing process for dentists include expired malpractice insurance, reliance on employer-provided coverage. Insurance companies often require a finalized bill of sale before approving contracts, further delaying the process. Keeping dental licenses and CAQH profiles updated is crucial, especially when transitioning between states. Working with professionals early on helps streamline the process, ensuring all necessary documents are in place to avoid unnecessary delays.19:10 How Long Does it Take to Get CredentialedWhile some claim it can be completed in as little as two weeks, the reality depends on factors like whether the provider is joining an existing practice or establishing a new entity with its own tax ID and NPI. The process involves multiple contracts, including terminating old agreements, which can cause delays. A best-case scenario suggests a 12-week turnaround, but errors in applications or insurance company delays can extend the process. Proper expectations and persistence are key to navigating credentialing successfully.28:20 What Does Being Out of Network Mean?! Failing to properly prepare for network credentialing can create significant issues for dental practices, especially when patients realize they are unexpectedly out of network. This can lead to frustration, distrust, and potential financial concerns. But many offices make the transition harder than necessary by not fully understanding, in the interim, they can still honor network fees while awaiting credentialing. Proper planning and clear patient communication are key to ensuring a smooth transition and avoiding unnecessary complications. The importance of working with a trusted, experienced professional over the anecdotal advice given by peers who probably lack the firsthand experience involved in the credentialing processes. 36:05 Working With Credentialing CompaniesThe extensive effort and tracking involved in credentialing, underscoring that their goal is to complete the process as quickly and smoothly as possible. Despite misconceptions, delays often stem from insurance companies rather than credentialing firms, and the representatives frontline callers interact with may not have access to accurate information. Ultimately, they urge more understanding and patience, reinforcing that passion and expertise drive Next Level Consultants to achieve the best outcomes for their clients.

Join us for this Episode of Dental Unscripted with host Mike Dinsio, co-host Paula Quinn, and special guest Stefani Sandoval as they dive deep into the complex world of dental credentialing during practice acquisitions. Connect with Next Level Consultants Team to learn more about their Dental Credentaling Service‪CALL: (253) 234-5288‬ EMAIL: admin@nxlevelconsultants.comhttps://www.nxlevelconsultants.com/front-office-support.html0:00 Intro music 1:00  Episode intro Podcast AnnouncementsOur front office expert breaks down what every dentist needs to know about this crucial but often complex and frustrating process of getting credentialed We even discuss the differences between a practice ownership transition and simply moving from one practice to another as an associate.Common credentialing pitfalls to avoidEssential documentation you needThe truth about insurance company timelinesCritical differences between associate and owner credentialing3:00 The Credentialing ProcessWhen purchasing a dental practice, understanding both your current credentialing status and the seller's network participation is crucial. Credentials and reimbursements can vary per location so it can be insightful and strategic to mirror what the seller's existing insurance arrangements for a smoother transition.6:00 How to Prepare to Get Credentialed Getting accurate credentialing information during a practice transition can be challenging since brokers don't handle these details. Moreover, sellers are often unfamiliar with their own status. Front office team members manage this information and sellers may not request this information for fear of revealing a pending sale?! To verify individual doctor's credentialing status, dentists should proactively maintain copies of their insurance contracts. Direct contact with insurance networks to verify, and, when possible, inquire with front office staff about existing credentialing contracts. 14:50 Common Roadblocks and ChallengesCommon delays in the credentialing process for dentists include expired malpractice insurance, reliance on employer-provided coverage. Insurance companies often require a finalized bill of sale before approving contracts, further delaying the process. Keeping dental licenses and CAQH profiles updated is crucial, especially when transitioning between states. Working with professionals early on helps streamline the process, ensuring all necessary documents are in place to avoid unnecessary delays.19:10 How Long Does it Take to Get CredentialedWhile some claim it can be completed in as little as two weeks, the reality depends on factors like whether the provider is joining an existing practice or establishing a new entity with its own tax ID and NPI. The process involves multiple contracts, including terminating old agreements, which can cause delays. A best-case scenario suggests a 12-week turnaround, but errors in applications or insurance company delays can extend the process. Proper expectations and persistence are key to navigating credentialing successfully.28:20 What Does Being Out of Network Mean?! Failing to properly prepare for network credentialing can create significant issues for dental practices, especially when patients realize they are unexpectedly out of network. This can lead to frustration, distrust, and potential financial concerns. But many offices make the transition harder than necessary by not fully understanding, in the interim, they can still honor network fees while awaiting credentialing. Proper planning and clear patient communication are key to ensuring a smooth transition and avoiding unnecessary complications. The importance of working with a trusted, experienced professional over the anecdotal advice given by peers who probably lack the firsthand experience involved in the credentialing processes. 36:05 Working With Credentialing CompaniesThe extensive effort and tracking involved in credentialing, underscoring that their goal is to complete the process as quickly and smoothly as possible. Despite misconceptions, delays often stem from insurance companies rather than credentialing firms, and the representatives frontline callers interact with may not have access to accurate information. Ultimately, they urge more understanding and patience, reinforcing that passion and expertise drive Next Level Consultants to achieve the best outcomes for their clients.

About Erin Weber:Erin Richter Weber is a healthcare leader with 14 years at CAQH. She oversees CAQH CORE, advancing healthcare automation, and CAQH Insights, producing the annual Index report. Erin unites stakeholders to address industry challenges through data-driven innovation. Previously, she consulted for PwC and led research at the Advisory Board Company. She holds a Master's from Harvard and a Bachelor's from Cornell, making her a pivotal voice in healthcare standards and policy.About Don Rucker:Dr. Donald Rucker is the Chief Strategy Officer of 1upHealth and former National Coordinator for Health IT at HHS (2017–2021). He led the ONC's 21st Century Cures Act Interoperability Rule, enabling secure patient access to health data via standardized FHIR APIs. A board-certified physician with clinical informatics expertise, he co-developed the first Windows-based electronic medical record. Dr. Rucker holds degrees from Harvard, the University of Pennsylvania, and Stanford, blending medicine, technology, and leadership.Things You'll Learn:Provider data is the backbone of the healthcare system, powering everything from patient care to billing, and requires standardization to ensure accuracy.The healthcare industry needs to learn from the internet and establish a system similar to domain name services to reduce friction.Data quality is paramount for interoperability, requiring standardized definitions of data elements like location. To improve data, AI should be included. AI can be used to standardize the multiple sources of provider data by merging them and enhancing the quality of that data. The healthcare industry is behind other industries, and boldness comes from adopting solutions that have already been implemented elsewhere. Resources:Connect with and follow Erin Weber on LinkedIn.Follow CAQH on LinkedIn and visit their website.Connect with and follow Don Rucker on LinkedIn.Learn more about 1upHealth on their LinkedIn and website.Check out the latest annual CAQH Index Report here. 

In the final series of interviews from HFMA's Annual Conference, Erin Weber of CAQH discusses how providers can participate in the work of setting best practice guidelines, and Lori Zindl of OS Inc. and Rachel Dallman of Phelps Memorial Health Center talk about opportunities to learn from analytics.

Mike Pattwell, principal business advisor at Edifecs and Chair of the WEDI payment models work group, emphasizes the pandemic's impact on moving away from the fee-for-service model towards a value-based care model. Improving the administration of healthcare requires automation, new workflow solutions, and better data exchange to improve patient health.  He mentions three organizations, including CMMI, WEDI, and CAQH, working towards creating interoperability and seamless communication between payers and providers.   Mike explains, "We've been around for 26 years, and we've been developing solutions to help our clients, mostly payers and providers, and health systems, to operationalize and automate workflows to improve the administration side of healthcare so that they can focus on doing what they do well, which is taking care of members and patients." "Starting at the top, it would be The Center for Medicare and Medicaid Innovation (CMS) and the innovation center called CMMI. They're paving the future of healthcare for both payers and providers. They're supported by many other organizations. I'll briefly discuss three that I'm directly involved with and I believe are helping to develop and evolve healthcare. I call these three organizations “silent superheroes.” They are the invisible organizations doing the hard work of creating interoperability and seamless automation between payers and providers. For decades, they've been enabling the future of healthcare." #Edifecs #HealthInnovation #DIgitalTransformation #DigitalHealth #SDOH #Equity #HealthcareIT edifecs.com Listen to the podcast here

Mike Pattwell, principal business advisor at Edifecs and Chair of the WEDI payment models work group, emphasizes the pandemic's impact on moving away from the fee-for-service model towards a value-based care model. Improving the administration of healthcare requires automation, new workflow solutions, and better data exchange to improve patient health.  He mentions three organizations, including CMMI, WEDI, and CAQH, working towards creating interoperability and seamless communication between payers and providers.   Mike explains, "We've been around for 26 years, and we've been developing solutions to help our clients, mostly payers and providers, and health systems, to operationalize and automate workflows to improve the administration side of healthcare so that they can focus on doing what they do well, which is taking care of members and patients." "Starting at the top, it would be The Center for Medicare and Medicaid Innovation (CMS) and the innovation center called CMMI. They're paving the future of healthcare for both payers and providers. They're supported by many other organizations. I'll briefly discuss three that I'm directly involved with and I believe are helping to develop and evolve healthcare. I call these three organizations “silent superheroes.” They are the invisible organizations doing the hard work of creating interoperability and seamless automation between payers and providers. For decades, they've been enabling the future of healthcare." #Edifecs #HealthInnovation #DIgitalTransformation #DigitalHealth #SDOH #Equity #HealthcareIT edifecs.com Download the transcript here

Guest: Lauren Hastings, MS, CCC-SLP - For this passionate conversation, Lauren addresses common myths and roadblocks to setting up a private practice and then empowers us all to overcome them. So, if you need help with credentialing and have never heard of a “CAQH” or a “clearing house,” then don't worry! Lauren will cover all these questions and more in this episode.

Resources:EIN: https://www.irs.gov/businesses/small-businesses-self-employed/apply-for-an-employer-identification-number-ein-online   NPI: https://nppes.cms.hhs.gov/Proliability by AMBA: https://www.proliability.com/  CAQH: https://proview.caqh.org/PR/Registration  CMS Physician Fee Schedule: https://www.cms.gov/medicare/physician-fee-schedule/search/overview  Medicare Become a Provider: https://www.cms.gov/medicare/provider-enrollment-and-certification/become-a-medicare-provider-or-supplierGoogle Workspace: https://workspace.google.com/pricing.html  Referral link for SimplePractice: https://www.simplepractice.com/referral?p=e9a6f67f90 0:00 Intro 0:55 EIN & Business Entity 3:23 NPI 5:06 Liability Insurance 7:07 Register your business 9:26 CAQH 10:55 Credentialing with Insurance Providers 12:27 Financials 15:43 How will you see patients? 23:44 Marketing 36:57 Staying organized 39:23 Resources and Mentoring 41:44 Content Creation 42:49 Outro-------------------------------------------------------------- ● https://porrazzanutrition.com ● https://www.facebook.com/MyDietitianJourney ● https://www.instagram.com/mydietitianjourney/ ● https://mydietitianjourney.wordpress.com/ -------------------------------------------------------------- Felicia Porrazza is a registered and licensed dietitian with a masters degree in dietetics administration, an ACSM certified personal trainer, National Board Certified Health & Wellness Coach, college nutrition assistant professor, and owner of Porrazza Nutrition LLC and My Dietitian Journey. In her private practice, she works one-on-one with clients to help them develop an understanding of healthy eating and fitness. She specializes in combining plant-based eating with fitness programs, specifically targeting beginner strength-training. Felicia has been a mentor to Dietitians starting their own private practice and a dietetic internship preceptor for Dietetic students. Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for general educational purposes only.

We deep dive into the credentialing world with Stafani at Next Level Consultants. She is the front office coach at Next Level Consultants. We talk about the challenges of getting credentialed during a transition. We talk about the timeline, reimbursement fees, umbrella vs. direct, negotiating, in-network vs. not in-network... We asked Stafani what happens if you start billing before your are credentialed? ? ? Michael founder of Next Level Consultants and Stafani want to answer all the questions you might have walking into this process. ** TOP 10 "Must Have" Documents ** 1. Updated Malpractice 2. IRS SS4 Form 3. Office Cash Fee Established 4. CAQH application completion 5. Insurance carriers utilized in acquiring practice 6. Updated Resume/CV 7. DEA license 8. State license 9. Speciality Certificate 10. NPI Type 2 0:00 Intro Music 0:40 Introducing Episode 4:11 Avoid Pitfalls Getting Credentialed 11:39 Reimbursement Fees 15:50 Umbrella V.S. Direct Insurance Carriers 18:38 How Long Does It Take to get Credentialed 23:18 in-network V.S not-in-network 32:01 Impact of Billing Out of Network? SHOW HOST INFO: As a dental buyer representative, Michael Dinsio helps dentists buy dental practices step by step. With over a decade of experience and more than 500 dental transactions, Michael is a key opinion leader in the dental industry. This program helps walk dentists through the process of becoming a dental practice owner via dental practice acquisitions. If you would like a free consult with Michael or would like to work with Michael in the future visit his webpage. https://www.nxlevelconsultants.com/buyer-representation.html WE HAVE A WEBSITE ! ! ! Find all the content from SEASON 1: Start Up Unscripted... as well as SEASON 2: Dental Acquisition Unscripted, it's all in one spot here

On this episode we did an Ask us Anything event. We got into some great topics like; HIPAA Compliance, Authorizations, CAQH, and so much more!

On this episode of the podcast, I was joined by Jane Sarasohn Kahn of Health Populi and THINK-Health. Jane and I discuss: - US Healthcare System - Healthcare economics before Healthcare economics - Her Book: Health Consuming - Health Consuming vs. Health Citizenship - US vs. European Healthcare systems Jane is a health economist, advisor and trend-weaver to organizations at the intersection of health, technology and people. Jane founded THINK-Health after working with health care consultancies in the US and Europe. Jane's clients span the health/care ecosystem: technology, pharma and life sciences, providers, plans, financial services and consumer goods. She founded the Health Populi blog in 2007. Jane advises on strategy via environmental analysis, scenario and strategic planning. She is on the advisory boards of CanSurround, CAQH's U.S. Health Efficiency Index, the Health 2.0 Conference, healthBank, HIMSS Connected Health Committee, the Society for Participatory Medicine, Stupid Cancer, and WEGO Health. In her community of Phoenixville, PA, Jane sits on the Board of The Clinic, a free clinic for residents. Jane is a frequent speaker, listed with AHA's Speakers Express and Executive Speakers Bureau.

When a crisis disrupts claims volume and payments processes, what can payers and providers do to adjust? April Todd, senior vice president of CORE and explorations for CAQH, explores the coronavirus pandemic's impact on administrative transactions and how the past two years can inform healthcare stakeholders' reactions to future crises.

Hailing from a background in management at both an outsourced medical billing company as well as a busy plastic surgery practice, John Gwin is the founder of The Auctus Group – a financial and operations consulting firm for exclusively plastic surgeons and dermatologists. John has had the privilege of working with countless physicians for over a decade now, aiding and assisting them in process, workflow and growth. Aside from multiple speaking engagements with Nextech, ADAM, FFAS, MAPS, and beyond, John also serves in an advisory role with a mobile mohs group, Chicago Mohs, as a Principal at a plastics/derm specific MSO/CIN, Medovate, a Board Member with Brave, a non-profit striving to serve and educate the breast cancer community, and is a member of the Young Entrepreneurs Council. In this episode, Carl White and John Gwin discuss:Medical practice credentialing and contracting The first steps in the process of credentialingCreating a timelineSoftware implementation  Key Takeaways: Medical practice credentialing is letting an insurance carrier know who you are, where you are, how to contact you and what practice you're running. Contracting or securing a business contract with them is the next step. One of the first steps is to make sure your PECOS and CAQH are up-to-date, accurate, and ready to go. Have a checklist of the basic building blocks that you need to start your business and create a timeline and get the process moving as soon as possible. Make sure that your software is in place and that you're going through implementation with that software vendor. Each vendor has their own implementation timeline, but allow a sixty day space, at least, for this part of the process or more. “No matter what, you have to get your contract secured before your start date to have a guarantee… Even if you're ready and executed, their systems may take time to update. That's why you wnat to leave these extra buckets of time.” - John Gwin Connect with John Gwin:Website: www.auctusgroupconsulting.comEmail: john@auctusgrp.comLinkedIn: https://www.linkedin.com/in/john-gwin/ | https://www.linkedin.com/company/theauctusgroupInstagram: https://www.instagram.com/theauctusgroup/Facebook: https://www.facebook.com/TheAuctusGroup/ Connect with Carl White: Website: www.marketvisorygroup.com  Email:  whitec@marketvisorygroup.comFacebook:  https://www.facebook.com/marketvisorygroupYouTube: https://www.youtube.com/channel/UCD9BLCu_i2ezBj1ktUHVmigLinkedIn: https://www.linkedin.com/in/healthcaremktg/

Learn how the healthcare industry is addressing the broken knowledge/data supply chain through automation, patient data liberation and federal regulations at WEDI's Summer Forum, July 27-29 on Zoom. Enter the code PODCAST for 15% off your registration rate. Learn more at www.wedi.org Matthew welcome CAQH CORE Board Members Tim Kaja (Chair) and Linda Reed (Vice Chair). Tim is Senior Vice President at Optum Care and Linda is the Vice President and Chief Information Officer at St Joseph's Health.  For more than 20 years, CAQH has created shared initiatives to streamline healthcare administration. Today, CAQH technology-enabled solutions, operating rules and research help nearly 1,000 health plans, 1.6 million providers, government entities and vendors connect, exchange information and operate more efficiently. Matthew discusses CAQH CORE's origins, their current rule development efforts and latest pilot and measurement activities 

On this episode of the Dish on Health IT, guests April Todd VP at the Council for Affordable Quality Healthcare (CAQH) and Erin Weber Committee on Operating Rules for Information Exchange (CORE) Director at CAQH discuss driving adoption of transactions and standards in pharmacy and medical benefit, FHIR use cases such as prior authorization, burden reduction and return on investment as well as value-based care. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

On this episode of the Dish on Health IT podcast, guests April Todd VP at the Council for Affordable Quality Healthcare (CAQH)and Erin Weber Committee on Operating Rules for Information Exchange (CORE) Director at CAQH to discuss driving adoption of transactions and standards in pharmacy and medical benefit, FHIR use cases such as prior authorization, burden reduction and return on investment as well as value-based care.April opens the discussion by giving a brief overview of her professional career and time at CAQH. She notes her fortune in being able to work in almost every sector of the healthcare and healthcare policy space. April has had experience in government, the health plan side working in the consultant and IT space, and now with CAQH within the nonprofit sector. She mentions her learned appreciation of the diversity of perspectives and the need for agreement and alignment to make progress within the industry.Erin says her experience is in strategic revenue cycle consulting. She has done work with the Veterans Health Administration as well as with an advisory board company where she worked with hospitals and health systems around the country to identify and implement best practices. The mission of CORE speaks to April. She is passionate about bringing together disparate stakeholders to have difficult conversations around driving interoperability.Ken asks April and Erin to give an introduction into CAQH and its activities. They explain CAQH is a nonprofit organization focused on helping to streamline and simplify the business of healthcare, mainly the administrative space. The company can be divided into three parts. The research arm, called Explorations, works with the industry to gauge the progress towards automation and to identify areas of improvement. There is also a policy arm called CORE trying to work towards consensus on how to operate between plans and providers on transactions and standards. CAQH also brings solutions (utilities) to the industry, a central place to do things where a competitive approach doesn't make sense. Overall, the organization is really trying to bring people together to drive consensus. Ken asks how the industry is managing recent transformation. April states that as technology advances, the industry is going to need to learn to adapt more quickly. She believes we are always going to have a push and pull between existing standards and technology and new standards and technology. CORE is trying to facilitate organized industry advancement where there are common expectations. April notes there are always going to be organizations way ahead and others that trail behind. We're seeing the biggest challenge to be getting stakeholders aligned and moving in the same direction using similar processes.Erin adds that “attachments” mean clinical documentation (for CAQH and their participating organizations), and how you connect the clinical and administrative data to support where the industry is at now. She goes on to explain there is a lot of partially electronic and manual work being done to exchange this documentation for both prior authorization and claims, which is a significant source of administrative burden. A CAQH subgroup just completed the development of draft operating rules for prior authorization use case related to the exchange of attachments. The hope is those rules will be finalized later this year. A key aspect of the draft rules was how to consider how both X12 and FHIR transactions can work well together. We know this is what will have to happen for a successful transformation, so the group looked at the various exchange formats, and both are included in the draft rules.Jocelyn notes that as we see transformation happening, we must be cognizant of our massive investment in X12 and the fact it runs a large part of the world we operate in. However, we need to bring administrative and clinical data together to make the shift to value-based care. Looking at stakeholder roadmaps and pipelines, what is being prioritized is what's pushed from a regulatory standpoint. We need to make sure we're meeting everyone where they are today. We've seen if we don't acknowledge current state, then we don't get the adoption we expect. Jocelyn says the work CAQH and others are doing are going to be incredibly important for regulators to look at to make sure they have an inclusive answer, taking advantage of the existing technology, but also understanding people may want to leverage existing rails already in production.Ken asks April about CAQH's methods for determining cost reductions, time savings, burden reduction, etc. for standardized transactions. What are the findings? April says one of their methods is through their explorations program, particularly the CAQH Index that surveys payers plans, providers and vendors in the industry. The goal is to understand the volume of different types of transactions. How are they conducted? Are they done manually? If your phone and fax and mail? Are they done electronically using the standards that have been established? What is the cost of staff time to do all the transactions? More recently, the survey included questions about value-based care, the use of FHIR and the impact of COVID on transactions.Jocelyn reinforces the importance of the survey as we must measure things in order to understand where we're making progress and where there are barriers. The goal is to get people to move to automation.Ken asks the group why the use case of prior authorization has the lowest level of adoption and what could improve the current situation. Erin says there is a lack of understanding around the breadth of information available in the transaction. She was surprised by the number of providers they spoke to who were unaware of the HIPAA transaction, despite the work done to educate the industry. Erin did see a bit of an uptick in the automation of prior authorization in the CAQH Index from 2019 to 2020. CAQH CORE has developed a set of prior authorization operating rules addressing things like additional data content needs to convey documentation needs. The industry needs to continually adopt and align expectations across various transactions and standards available. Ken asks what role CAQH plays in the adoption of value-based care. Erin notes that, just as when CAQH CORE was founded and HIPAA transactions were first being implemented, the board is feeling some of the same pain points. Even though you may have standard processes and ways of doing things, everyone will still do things just a little bit differently, which makes it hard to automate and can create real burdens. The board proposed conducting research to really understand where there might be opportunity to create some more uniformity in the industry and reduce that administrative burden, improving information change and enhancing transparency across the clinical and administrative verticals. Erin says you can't look at value-based care and fee for service as two separate worlds, it's a continuum. They approached research by looking at the revenue cycle, across fee for service and value-based payments, and tried to understand where there needed to be differences where there were different data needs.April discusses next steps. She says they have a priority list from the advisory group and attribution was identified as most important. They are also monitoring FHIR, and progress being made there. April says they are currently working on things we can do in the exchange of information to support quality measures and gaps in care. They are conducting an environmental scan to gauge what is happening and what could be done to simplify. Overall, she thinks CAQH's role is aligning and bringing stakeholders together to create common expectations. Erin's gives her final thoughts. She asks that if you see a request for their Index, please respond. She also brings up the fact that they have been working to help put a utility out to support the CMS and ONC interoperability rules and to help people connect to have a trusted place of information around FHIR.

What is CAQH?CAQH (Council for Affordable Quality Healthcare) is nothing more than a giant database of credentialing information. Insurance companies and other credentialing entities pay to access  the information but is free for YOU, the provider.What does CAQH do and why is it important to you?If you want to be credentialed by an insurance company, you have to send them a whole bunch of documentation--licenses, proof of malpractice, your DEA/state CDS and more. And when each document expires, you have to provided updated documents. Using CAQH allows you to upload the documents in one central location and have them disseminated to insurance companies rather than having to send the documents to each individual insurance company. It will save you a huge amount of time.CAQH does not submit application to the insurance companies or complete the credentialing process for you.How to register with CAQH?Have all of your documents ready for uploading. Make sure your CV is updated. You'll need your license, DEA/CDS, proof of malpractice, CV, W9, proof of board certification, diplomas, and proof of hospital privileges (if applicable.)Have three professional referencesIf you are starting a practice you'll also need information about the new entity: the legal entity info, tax id #, address (including payment and correspondence if they're different), billing company info if you are outsourcing, credentialing contact, billing contact, hours of operation, phone/fax, group NPI (if you have multiple providers) and your NPI. Once you have everything ready, go to https://proview.caqh.org/pr/registration/selfregistrationAt the end of your application you need to grant access to the payers. In order to do this you MUST submit a signed ATTESTATION form provided by CAQH.Once you have signed and dated the attestation, make sure to upload the document (or nothing will happen).Save your CAQH ID#, user id and password in a safe place. Check CAQH at least every 60 days to make sure there's nothing that needs attention.Can you do this yourself? Yes, absolutely. The majority of the time and effort comes from gathering all of the information. You will need to do this part regardless of whether you enter the data in the portal or you outsource it. Click here to get  my free How To Start Your Own Private Practice Cheat Sheet.If you'd like to hear more tips on how to start, run and grow your practice and related medical businesses, please sign up for my newsletter at https://www.thepracticebuildingmd.com.    And, be sure to join my FB group, The Private Medical Practice Academy. Enroll in my course,  How To Start Your Own Practice and get the step-by-step process for opening your doors. Or join The Private Medical Practice Academy Membership for live group coaching, expert guest speakers and everything you need to know to start, grow and leverage your private practice.

It’s no secret that achieving fully electronic prior authorization is a challenge, but the potential upside is tremendous—to the tune of $454 million in savings, according to the 2019 CAQH Index Report. On today’s show, Andrew Johnson meets with our special guest from CAQH, April Todd, to shed light on areas around prior authorization that remain the most challenging, the benefits of transitioning to an automated workflow, and efforts underway to speed adoption of electronic prior auth. Today’s panelists are Andrew Johnson, vice president of Electronic Prior Authorization Solutions for Change Healthcare, and April Todd, senior vice president for the CAQH, a non-profit alliance creating shared initiatives to streamline the business of healthcare. They unpack: The purpose and role of the CAQH CORE (Committee on Operating Rules for Information Exchange) Why prior authorization is a challenge for payers and providers Update on alignment between industry standards bodies, including CAQH, WEDI, and HL7 Da Vinci Which areas of healthcare are furthest along in adopting electronic prior authorization CAQH’s latest research on the cost of manual versus automated transactions How electronic prior authorization drives better patient care and reduces costs Building blocks of an ideal prior authorization workflow Steps Change Healthcare and CAQH are taking to advance electronic prior authorization How COVID-19 is affecting adoption Timeline for shifting prior authorization into a fully automated process How listeners can support electronic prior authorization advancement Episode Resources April Todd’s bio Andrew Johnson’s bio CAQH website CAQH Index CAQH Core The "Intelligent" 278: Creating a Standard for Shared Decision Support InterQual Connect How InterQual Connect works Automation and Appropriate Care Change Healthcare Industry Insights COVID-19 Updates and Resources COVID-19 Updates Newsletter Change Healthcare Insights Newsletter Show Resources SUBSCRIBE to the podcast using any podcatcher or RSS reader Suggest or become a guest Contact Change Healthcare

Prior authorizations play a key role in checking on the safety and appropriateness of medical treatments among patients, but when they take too long, efficiency of care suffers. On this episode of Managed Care Cast, we speak with April Todd, senior vice president, CORE and Explorations for CAQH, on CAQH CORE’s recent approval of a 2-day rule for health plans in requesting additional supporting information from providers and making final determinations on prior authorization requests. CAQH CORE is a multi-stakeholder collaboration aimed at creating healthcare operating rules for electronic administrative transactions and establishing a common foundation for the operational components of value-based payment.

$11.1 Billion. That's how much, according to the 217 CAQH Index, the healthcare industry could save by transitioning to fully electronic administrative transactions. The transactions are for things like claim submission, eligibility and benefit verification, pre-authorization, etc. These are clearly defined standards and many of them are widely adopted. This is real interoperability in healthcare and it's in place today. Yet, not everyone is participating. Why is that? How can we expand adoption and realize the tremendous value that's available for the taking? And what can we learn from this process to help us achieve real interoperability in other areas of healthcare? My guests today Dr. Kristine Burnaska, Director of Research and Measurement at CAQH and Reid Kiser, Lead Researcher of the 2017 CAQH Index tell us how the CAQH Index measures the cost of administrative transactions in healthcare and gives us a detailed look into the industry's progress. More importantly, they help us to understand the tremendous opportunity we have in front of us.   NOTE: This is also the topic for the #HITsm chat on Friday, August 17th at 12 EST that I'm co-hosting with CAQH: The Cost Savings Opportunities on the Business Side of Healthcare – #HITsm Chat Topic   0:00 This is real interoperability in healthcare. Why isn't everyone on board? 2:13 Background on CAQH – Nonprofit alliance of health plans that acts as the convener, collaborator and catalyst for streamlining the business of healthcare. 5:34 The CAQH Index – The best measure of efficiency in the cost of administrative transactions between doctors and health plans. 10:11 The CAQH Index has informed operations staff how their facility measures up to the competition and makes the business case for administrative technology investments. 14:35 What did the 2017 report say? What are the types of transactions being tracked? The 13 metrics: Claim Submission, Eligibility and Benefit Verification, Claim Status Inquiry, Claim Payment, Remittance Advice, Prior Authorization, Referral Certification, Coordination of Benefits Claim, Claim Attachment, Prior Auth Attachment, Enrollment and Disenrollment, Premium Payment, and Acknowledgements. 18:30 Electronic vs Manual Transactions. 22:20 What are Partially Electronic Transactions? An introduction to portals. 25:25 The 2017 Report: Why is claims submission 95% electronic? 30:04 The 2017 Report: What have prior authorizations not improved since 2008? 33:21 The dollar savings opportunity for improving prior authorization is $11.1B, $9.5B from provider side, and it's still growing. What are the numbers really telling us? 37:51 Why have high deductible health plans increased the number of manual transactions? Are we still going in the right direction? 39:05 Why certain organizations are adopting and some aren't, who's doing well, and what we learn from best practices. 42:55 Portals and Passover – why is this metric different than all other metrics? The increase in portal use is driving increase in manual transaction rates. Are portals a bridge or barrier to full automation? 48:13 Where does the report focus on in 2018? New topics include: Portal use, value based payments, vendor fees, and call inquires. Like all CAQH initiatives, the CAQH Index is the result of an industry-wide collaborative effort. Health plans covering more than half of the commercially insured U.S. population and a wide range of healthcare providers contribute data on how many of the studied transactions they conducted throughout the year and how they conducted them. They are joined by vendors and other business partners in offering insights about dynamic market conditions driving decisions about use of administrative transactions. Government agencies and policymakers often contribute data and insight to the Index as well. Advance the Effort. Health plans and healthcare providers can advance the effort by contributing data. For the 2018 CAQH Index, more data is needed to more completely benchmark the transactions currently tracked and to reveal insights about the evolving use of administrative transactions. Every Contribution Adds Value. Every data contribution enriches the overall quality of the Index dataset. With richer data, CAQH can deliver increasingly useful insights, more precise measures of progress, and more accurate estimates of cost savings. All health plans and providers, regardless of adoption status, are encouraged to participate. Receive a Customized Benchmark Report. Health plans and healthcare providers that contribute data receive customized benchmark reports. CAQH prepares and delivers a detailed analysis of organizational performance alongside national results to each data contributor.   About Kristine Burnaska, Ph.D. Director, Research and Measurement, CAQH Kristine Burnaska, Ph.D. is Director, Research and Measurement, at CAQH, a non-profit alliance of health plans and related associations working together to achieve the shared goal of streamlining the business of healthcare. Kristine manages CAQH Explorations and in that capacity is the lead researcher for the annual CAQH Index, which tracks the healthcare industry transition from manual to electronic business transactions and the related cost savings. Before joining CAQH in 2018, Kristine was the Director of Operations at the Health Care Cost Institute, where she focused on understanding and guaranteeing smooth daily operations of its price transparency initiative. She previously served the Health Industry Distributors Association as Director of Research and Market Intelligence and Abt SRBI as Director of Analytics / Consumer Insights. Kristine holds a Ph.D. in statistics and research methods from the University of Illinois at Urbana-Champaign. Reid Kiser, MS Lead Researcher, 2017 CAQH Index Reid Kiser was the lead researcher for the 2017 CAQH Index in his former capacity as Interim Director of CAQH Explorations, the research arm of CAQH, a nonprofit alliance of health plans and related associations. An independent consultant with Kiser Healthcare Solutions, Reid is a former employee of CAQH. He managed the transition of the U.S. Healthcare Efficiency Index, the predecessor to the CAQH Index, to CAQH in 2012. Prior to his role at CAQH, Reid served in several capacities involving quality measurement and improvement for health plans and providers. He was an executive lead for Inovalon's HEDIS Advantage™ and served as UnitedHealthGroup's National Director of Clinical Excellence. He also served in a variety of capacities at NCQA. He holds a Master of Science in evaluative clinical sciences from Dartmouth. About CAQH and The CAQH Index CAQH is a non-profit alliance of health plans and related associations working together to achieve the shared goal of streamlining the business of healthcare. The CAQH Index is the industry source for tracking health plan and provider adoption of electronic administrative transactions. It also estimates the industry cost savings opportunity, an amount that should decline as adoption and efficiency grows. The CAQH Index is the authority on: Claims-related administrative costs for medical and dental providers and health plans. Time consumed by providers. Savings potential from conversion to fully electronic administrative transactions. Trends in use of fully electronic (HIPAA), online portal, phone, fax, mail and interactive voice response (IVR) transactions. Related and/or Mentioned on the Show All resources below are complimentary and available at the CAQH website. About the CAQH Index The 2017 CAQH Index Report Participate in the CAQH Index! Follow and engage with CAQH on: Twitter @CAQH LinkedIn CAQH Email at Explorations@CAQH.org CAQH Soultions collaborates for shared utilities. COB Smart helps coordinate your benefits. CAQH Proview AKA the Universal Provider Datasource uses an intuitive, profile-based design, for providers to easily enter and maintain their information for submission to selected insurance organizations. ENROLLHUB helps payers send providers electronic payments. Sanctionstrack for automated sanctions monitoring. CAQH Core drives the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers and consumers. Use the Savings Calculator to estimate potential organizational savings by transitioning to electronic administrative transactions! In addition, CAQH invites those who share its passion for reducing the cost, time and frustration associated with the business of healthcare to stay informed about this and other work at CAQH by signing up for its email newsletter. Subscribe to Weekly Updates If you like what we're doing here, then please consider signing up for our weekly newsletter. You'll get one email from me each week detailing: New podcast episodes and blog posts. Content or ideas that I've found valuable in the past week. Insider info about the show like stats, upcoming episodes and future plans that I won't put anywhere else. Plain text and straight from the heart :) No SPAM or fancy graphics and you can unsubscribe with a single click anytime. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar

On this episode of the NP Dude podcast it’s another hodgepodge show of new grad questions about credentialing, billing practices, and when to discuss planned vacations during negotiation.  I also spend some time giving my perspective on personal responsibility as a nurse, NP student, and life in general.  Keep sending comments and questions to me […] The post Episode 134 – Billing, Credentialing and Vacation Questions From New Grads and Personal Responsibility! first appeared on The NP Dude.

This week I touch on a few things I’ve noticed in my area lately. Consider revisiting some policies and protocols from time to time, to make sure you are in compliance with state and federal regulations. I found out from my Marketing Director that OSHA has been paying some visits to dental offices in Tennessee, checking if our business is up-to-date with their requirements. As you might be aware of, we have a problem here in Tennessee with opioid prescriptions. The state legislature is trying to tackle it by passing a new bill, which I’m not so excited about. I also speak about a new credentialing organization we recently switched to, and some DEA visits I heard about from an oral surgeon friend of mine. Key takeaways: Revisit the OSHA compliance in your state A potential new bill regarding the opioid problem in Tennessee An alternative to CAQH and some DEA visits Links: ICD-10 Codes 2018 CAQH Availity Want to receive our podcast on a weekly basis? Subscribe to our newsletter!

On this episode, the fourth in our ongoing Provider Directory Series, we continue to unravel the "why" behind provider directory inaccuracies. One major theme that's emerged is that we have a context gap between health plans and providers. That is, even when we're asking the right people at the right time, we might be asking the wrong questions. Our guest, Ron Urwongse, a Senior Product Manager at CAQH, explains how adding a level of specificity to our questions can yield dramatically different results. For example, if you ask a provider if they work at an office, they may say yes even if there's only a slight chance they ever will (i.e. to cover for a colleague). The tendency, Ron explains, is that providers play defense - they don't want to have a claim denied if they ever do submit one from that office. By adding some specificity to our questions, we could cut down on the confusion. How often do you work at this office? Or, do you accept new patients at this office? Are bound to yield more accurate results. These follow-on questions help the providers to understand what they are truly being asked. We can add even more context by making sure they know how the information is going to be used. Where do you bill from so that our billing department can process your claims properly? Where should our provider directory list you as accepting new patients? Ron and I discuss this context issue and so much more, including: What is provider data? (2:00) Besides demographics, what else do we need to know about providers? (4:00) In addition to patients, who else is affected by bad provider data? (5:30) We're spending billions of dollars managing provider directories. Why are they still broken? (8:15) Is it fair to place accountability on the providers and put pressure on them to resolve this issue? (10:57) What are the proposed penalties from CMS for Medicare Advantage plans whose directories fall out-of-date? (11:50) Has anyone been fined yet? (12:10) Do health plans do a good job of sharing provider information across departments within their own organization?  (12:10) Why can't I just go to NPPES? Why aren't the doctors keeping their data updated? (15:00) Why do providers (and their groups) report that they work at locations that they don't work at? (17:37) Why do providers feel that their data submissions fall into a black hole once submitted? (20:00) The typical 5 -doctor practice has 12 contracts and each of them requires 140 data points. That's 8,400 data points for a relatively small practice. (21:20) Are the regulators being reasonable in their demands? (23:30) How does contracting and reporting at the group-level cause problems for provider directories? (25:30) Is there any reluctance to share because of security/privacy/competitive concerns? (29:15) How does the expansion of the care team make this problem more complex? (31:40) What's happening on the solution side? (33:15) How can we foster safe collaboration among industry competitors? (34:10) A call to reduce provider burden, while simultaneously raising their accountability. (35:00) What is the minimum necessary data set for provider directories? (38:30) What is CAQH doing to solve the problem of bad provider data/inaccurate provider directories? (37:00) I hope you enjoy it! - Don Lee   About Ron Urwongse and CAQH Ron Urwongse is a Senior Product Manager at CAQH. Ron guides the cross-functional team responsible for CAQH ProView. Previously, he led product development and operations at Tyrula LLC, focusing on risk adjustment and quality improvement solutions in managed care. At Vecna Technologies, Ron served as a product manager. He also led the development of a billing solution for the Massachusetts Commonwealth Connector, the first state health insurance exchange website. Ron received his MBA from the MIT Sloan School of Management, Master's Degree in Information Systems Management from Carnegie Mellon University, and B.S. degree in Information Systems from Carnegie Mellon University. CAQH, a nonprofit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients, and health plans. COB Smart® quickly and accurately directs coordination of benefits processes. EnrollHub® reduces costly paper checks with enrollment for electronic payments and electronic remittance advice. CAQH ProView® eases the burden of provider data collection, maintenance, and distribution. SanctionsTrack® delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions. DirectAssure® helps health plans increase the accuracy of provider directories. CAQH CORE® maximizes business efficiency and savings by developing and implementing federally mandated operating rules. CAQH Index® benchmarks progress and helps optimize operations by tracking industry adoption of electronic administrative transactions. Learn more: CAQH Home: https://www.caqh.org/ Provider Data Action Alliance: http://CAQHProviderData.org Provider Data Tools from CAQH: http://ProviderDataManagement.org Defining Provider Data Whitepaper: https://www.caqh.org/about/defining-provider-data-white-paper Twitter: @CAQH Mentioned on the Show JAMA: The Accuracy of Dermatology Network Physician Directories Posted by Medicare Advantage Health Plans in an Era of Narrow Networks Health Affairs: Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans CMS Online Provider Directory Review Report About the Provider Directory Podcast Series This episode is part of our ongoing Provider Directory series that aims to dissect the issue from all perspectives, including provider, payer, patient, and regulator. Our goal is to help facilitate an expanded national conversation that drives us towards an open, collaborative industry solution. Check out all our Provider Directory posts and episodes here! Weekly Updates If you like what we're doing here, then please consider signing up for our weekly newsletter. You'll get one email from me each week detailing: New podcast episodes and blog posts. Content or ideas that I've found valuable in the past week. Insider info about the show like stats, upcoming episodes and future plans that I won't put anywhere else. Plain text and straight from the heart :) No SPAM or fancy graphics and you can unsubscribe with a single click anytime. The #HCBiz Show! is produced by Glide Health IT, LLC in partnership with Netspective Media. Music by StudioEtar

In Part 2 of the Credentialing Series, Danielle asks Katia about the next steps after completing her CAQH profile. Katia answers questions about how to find insurance panels in your area and how to go about applying to panels. Visit our Facebook page for show notes and resources for this episode. 

In Part 1 of the Credentialing Series, Katia asks Danielle all about the first step in the credentialing process, making your CAQH profile. Visit our Facebook Page for show notes and links to the items discussed in this episode.