improve it or discuss these issues on the talk page . learn how and when to remove these template messages this article needs additional citations for verification . please help improve this article by adding citations to reliable sources . unsourced material may be challenged and removed . december 2013 learn how and when to remove this template message the topic of this article may not meet wikipedia s notability guidelines for companies and organizations . please help to establish notability by citing reliable secondary sources that are independent of the topic and provide significant coverage of it beyond its mere trivial mention . if notability can not be established the article is likely to be merged redirected or deleted . find sources caqh news newspapers books scholar jstor free images december 2013 learn how and when to remove this template message this article contains content that is written like an advertisement . please help improve it by removing promotional content and inappropriate external links and by adding encyclopedic content written from a neutral point of view . february 2016 learn how and when to remove this template message learn how and when to remove this template message caqh streamlining the business of healthcare . industry health care information technology headquarters washington dc united states divisions caqh core caqh solutions caqh explorations website http www.caqh.org caqh legal name council for affordable quality healthcare is an american non profit organization established in 2000 and based in washington dc . its mission is to accelerate the transformation of business processes in healthcare through collaboration innovation and a commitment to ensuring value across stakeholders 1 including healthcare providers trade associations and health plans . 2 caqh has created a number of initiatives to streamline the business of healthcare caqh core caqh solutions and caqh explorations . caqh solutions include caqh proview sanctionstrack enrollhub and cob smart . caqh explorations the research arm of caqh includes the caqh index . caqh core established in 2005 caqh core the committee on operating rules for information exchange is a multi stakeholder collaboration of more than 140 organizations providers health plans vendors government agencies and standard setting bodies committed to the development and adoption of national operating rules for administrative transactions within the healthcare industry . caqh core participating organizations include health plans representing more than 75 % of commercially insured lives plus medicare and medicaid beneficiaries . the affordable care act aca mandated better standardization of the electronic hipaa administrative and financial transactions between providers and insurers . 3 in 2012 caqh core was designated by the department of health and human services hhs as an author for aca mandated operating rules . 4 5 operating rules support a range of existing standards to make electronic data transactions more predictable and consistent regardless of technology used . 6 the caqh core process centers on an integrated model consisting of rule development testing and certification outreach and tracking measures . in 2012 2013 the organization released operating rules for four transactions now federally mandated for all hipaa covered entities eligibility claim status electronic funds transfer and remittance advice eft era . in 2015 it announced additional voluntary operating rules for healthcare claims prior authorization employee premium payment and employee enrollment and disenrollment . 3 to drive and track market adoption caqh core offers a voluntary certification program so organizations can demonstrate that they have adopted and are adhering to the operating rules . 6 organizations that create use or transmit administrative healthcare data such as health plans healthcare providers and vendors can earn core certification . in a january 2014 proposed rule hhs recommended caqh core as the administrator for hhs required certification of health plans . 7 caqh solutions caqh has developed several collaborative solutions to address the need of the healthcare industry to reduce business costs and inefficiencies . launched in 2002 and formerly known as the universal provider datasource caqh proview is used by more than 1.3 million healthcare providers to self report professional and demographic information . health plans hospitals and provider groups may utilize this information for provider credentialing network directories and claims payments . 8 use of caqh proview reduces time and resources needed for these processes ; it can also minimize manual error and reduce duplicative paperwork and administrative costs . 9 sanctionstrack an add on feature to caqh proview is an automated continuous sanctions monitoring solution that reviews multi state information on provider licensure disciplinary actions . 10 sanctionstrack helps organizations eliminate redundant data gathering and follow up research for sanction notices . increasing adoption of electronic funds transfer eft and electronic remittance advice era enrollment continues to challenge healthcare organizations . to simplify this process caqh launched enrollhub in 2013 to offer providers a single enrollment process for eft and era with multiple payers . 11 providers complete the standardized electronic enrollment form and select the health plans with which they do business . caqh notifies the health plans of the enrollment and the health plan then accesses the provider s banking information . 12 used by health plans and clearinghouses cob smart helps identify instances of patients with overlapping insurance coverage . this caqh solution determines which individuals have benefits that should be coordinated as well as which health plans are primary and secondary insurers so that corresponding claims can be processed correctly the first time . cob smart launched in 2014 . 13 caqh explorations caqh explorations is the research arm of the caqh . it includes the caqh index which tracks and reports progress by the healthcare industry in its ongoing transition from manual to electronic administrative transactions . 14 the findings of the caqh index are based on an analysis of an extensive dataset of administrative transactions between providers and health plans . the 2014 caqh index reported that providers and health plans could potentially save 8 billion if they fully adopted electronic transactions . 15 caqh membership members include aetna anthem america s health insurance plans aultcare the bluecross blueshield association blue cross blue shield of michigan bluecross blueshield of north carolina bluecross blueshield of tennessee carefirst bluecross blueshield cigna health net horizon blue cross blue shield of new jersey kaiser permanente and unitedhealth group . references edit at ahip institute collaboration is the name of the game . . fiercehealthpayer . june 2015 . www.caqh.org . a b four updated hipaa transactions coming by mid 2016 . . health data management . september 28 2015 . engagement with standards and operating rules . centers for medicare & medicaid services . www.cms.gov . caqh offers tool to simplify transactions . modernhealthcare . february 2013 . a b voluntary operating rules approved for insurance transactions . . hfma healthcare business news . september 2015 . administrative simplification certification of compliance for health plans . department of health and human services . january 2014 . ahip payers team up to reduce administrative waste . . fiercehealthpayer . june 8 2015 . technology to streamline physician credentialing . . fiercehealthpayer . july 2015 . vendor notebook carestream wins government contract . . healthcare it news . may 2011 . switching to the healthcare eft standard 4 ways to ease the transition . . healthcare finance . september 16 2015 . solving the eft enrollment challenge for providers . . health data management . february 2015 . horizon bcbs deploys coordination of benefits tool . health data management . march 2014 . e transactions could save providers plans 8 billion per year . . cardiovascularbusiness . march 2015 . electronic transaction could save healthcare billions . revcycleintelligence . march 2015 . external links edit ahip payers team up to reduce administrative waste . fiercehealthpayer june 2015 . healthcare eft via ach volume exceeds 149 million transactions in 2014 . nacha february 2015 . how to identify who sent your healthcare eft payment . health data management march 2015 . debunking myths about healthcare eft . health data management august 2015 . cob smart to improve accuracy of cob in the health care industry . bcbsnc . service aims to end health coverage conflicts . lifehealthpro february 2014 . caqh offers tool to simplify transactions . modernhealthcare february 2013 . aetna to insist on core standards certification . lifehealthpro february 2008 . how electronic transactions could save healthcare 8b 6 areas of opportunity . becker s hospital review august 2014 . study switch from manual to electronic transactions could save healthcare 8b . becker s hospital review march 2015 . caqh electronic transactions could save healthcare billions . ehr intelligence august 2014 . hhs to strengthen enforcement of hipaa transaction rules . informationweek january 2014 . retrieved from https en.wikipedia.org w index.php title caqh & oldid 704986045 categories non profit organizations based in washington d.c.hidden categories articles needing additional references from december 2013all articles needing additional referencesarticles with topics of unclear notability from december 2013all articles with topics of unclear notabilityarticles with a promotional tone from february 2016all articles with a promotional tone navigation menu personal tools not logged intalkcontributionscreate accountlog in namespaces article 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