CAQH Administrative Simplification Committee Summary of January by jolinmilioncherie


									                         CAQH: Administrative Simplification Committee
                          Summary of January 14, 2010 Conference Call
                       Confidential -- Contains Proprietary Business Information

Participating Plans
Aetna: Kurt Small
Blue Cross Blue Shield Association: Rich Cullen
Blue Cross Blue Shield of MI: Kim Sorget
Blue Cross Blue Shield of NC: Janet Jackson
Blue Cross Blue Shield of TN: Mark Austin
Health Net: Jay Gellert

CAQH: Sorin Davis, Gwen Lohse, Debbie Routt, Pat Smith, Robin Thomashauer, Steve Zlotkus

Discussion Points and Next Steps
  Agenda Item                               Key Discussion Points                             Outcomes/Next
 Review                  Jay Gellert reviewed the Antitrust Guidelines.
 Review of               Committee members did not have any questions pertaining to           Minutes approved
 September 21,           the 9/21/09 call minutes.
 2009 call
 minutes (Doc
 Administrative      Jeanette Thornton, AHIP, gave an update on the status of
 Simplification      administrative simplification as it relates to health reform. She
 and Health          outlined the components of both the House and Senate bills
 Reform              regarding operating rules and discussed the different approaches
                     included in the draft legislation.

 State Strategy      Robin Thomashauer provided the update regarding the CAQH state
 Update and          strategy:
 Plans for 2010          There is a great deal of activity at the state level focused on
 (Doc 3)                 supporting providers in the adoption of electronic health records.
                         The majority of the activity is being driven by the HHS Office of
                         the National Coordinator (ONC).
                         Funding is available for providers to adopt electronic health
                         records, and for state support organizations to assist providers
                         with the implementation.
                         Meaningful use of the technology plays an important role in this
                         process. At the end of December rules were promulgated by
                         CMS and ONC. These rules are currently in the review period,
                         with comments due by March 15 .
                         CAQH is reaching out to states to educate stakeholders as to
                         how CORE and UPD can provide foundational elements for
                         required components of state health information exchanges;
                         CORE as a basis for the exchange of electronic eligibility
                         information and the UPD for provider directories.
 CORE (Doc 4)        Gwen Lohse provided the update on CORE:
                        The CORE Steering Committee Chair will be transitioning out of
                        BCBSNC but will remain as Chair through the end of Phase III
                        Rules approval.
                        Organizations continue to join CORE and participate as well as
                        certify for Phases I and II. Aetna and WellPoint are now Phase
                        II certified.
                        Phase III rule writing is progressing. The status of the rules is
                        described in the call documents.
Doc # 2 – Admin Simplification Committee Call 03-16-10                                                        1
                         CAQH: Administrative Simplification Committee
                          Summary of January 14, 2010 Conference Call
                       Confidential -- Contains Proprietary Business Information

  Agenda Item                               Key Discussion Points                            Outcomes/Next
                         2010 CORE strategy has been developed with several options,
                         depending on the outcome of health reform. Three options were
                         outlined for the Committee.
 UPD (Doc 5          Kurt Small, Aetna, provided an update on UPD:
 and 6)                  Provider adoption has exceeded 2009 goal of 775K one month
                         For 2010, CAQH will continue to focus on the use of the data
                         beyond credentialing – highlighting data quality and
                         demonstrating ROI for participating organizations.
                         New organizations continue to subscribe – 2010 will focus on
                         remaining large payers, hospitals and state Medicaid agencies.
                         As for the UPD year-end report, provider and administrative fee
                         revenue is tracking to exceed year end goal. Sanctions Track is
                         also ahead of projections. Strong revenue performance is a
                         result of new business and increasing provider adoption and
                         completion rates.
                         System stabilization and modernization remains on track as
                         ACS learns more about the system structure and functionality
                         A pilot program allowing doctors to elect to receive quotes on
                         malpractice insurance launched in three states – KY, MI, and
                         OH. Utilization has been limited, but CAQH has been working
                         with the vendor to make this option appealing to the provider
                         CAQH confirmed via a survey that 62% of participating
                         organizations still need the UPD to require the capture of the
                         provider SSN. The use of the SSN as an identifier is a growing
                         concern for the provider community. CAQH may consider
                         convening a multi-stakeholder group to explore alternative

                     Kim Sorget walked through an update of the Primary Source
                     Verification Feasibility Study:
                         The report was released in May, outlining an approach including
                         continuous monitoring of certain required documentation. While
                         significant discussions have taken place among key
                         stakeholders, this is a sensitive matter. Feedback has been
                         positive, although next steps are being planned with respect to
                         the different stakeholder groups. These steps will likely include
                         more definition and prototype testing of the process and
                         functionality in order to demonstrate value.

                     Sorin Davis reported on the 2010 UPD focus and strategy:
                         Goals reflect a changing and competitive environment.
                         Improving data quality to 97% accuracy and advancing the
                         primary source verification are key steps.
 CAQH 2010               The Board has been discussing ways to engage other
 (Doc 7)                 stakeholders in the CAQH process. This will be discussed in
                         more detail in the coming year.
                         2010 is the tenth anniversary of CAQH; and messaging will be
                         developed to celebrate this milestone.

 2010 Schedule           The next scheduled call is March 16 .

Doc # 2 – Admin Simplification Committee Call 03-16-10                                                       2
                         CAQH: Administrative Simplification Committee
                          Summary of January 14, 2010 Conference Call
                       Confidential -- Contains Proprietary Business Information

Doc # 2 – Admin Simplification Committee Call 03-16-10                             3

To top