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CAQH Launches New Solution to Improve the Provider Credentialing Process
Goal is Industry-wide Sharing of Primary Source Verification Data for Healthcare Providers
(April 04, 2017)

WASHINGTON, April 4, 2017  /PRNewswire-USNewswire/ -- The non-profit alliance CAQH today announced the launch of a new electronic solution, VeriFide, that streamlines primary source verification of the healthcare provider information required for health plan credentialing decisions.


VeriFide will immediately improve the quality, speed and integrity of provider data sent to health plans as part of the credentialing process. Over time, plans will be able to share a common data set of verified information for the providers in their networks, reducing administrative costs by eliminating the need for each plan to manage its own data verification process. The solution will also reduce the administrative burden on providers by decreasing the repetitive requests from multiple plans seeking the same information.

The National Council for Quality Assurance (NCQA) requires health plans to re-credential participating healthcare providers every three years. As part of that process, plans must verify 14 key provider data elements with third-party (i.e., primary) sources. Currently, each plan conducts its own data verification process, or works with a vendor to do so.

"We believe this initiative will be a game-changer for the industry. There is no business reason for each health plan to verify the same data for the same providers," said Bruce Edwards, Senior Vice President, Networks Management, CareFirst BlueCross BlueShield. "In addition to reducing business expenses, VeriFide will improve the synergy between providers and payers for the credentialing process."

The solution was developed in concert with credentialing experts from a number of health plans. Early in 2016, CAQH achieved NCQA-certification as a Credentials Verification Organization (CVO), a critical qualification. Once developed, VeriFide was piloted by CAQH member plans including Aetna, Blue Cross Blue Shield of Michigan, CareFirst BlueCross BlueShield and Health Net. CAQH is confident that VeriFide will achieve broad participation by health plans, enabling the industry to benefit from this shared verification process.

"Collaborating and sharing information among health plans is the simplest and most efficient way to get accurate provider information," said Thomas Simmer, M.D., Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield of Michigan. "This builds on what works so well with CAQH ProView to streamline the credentialing process as well."

VeriFide employs advanced technology to integrate seamlessly with CAQH ProView, which contains self-reported professional data from more than 1.4 million healthcare providers. The solution further automates the verification process by integrating with most primary data sources. This elimination of manual processes both reduces the time required for verification and reduces the likelihood of human error. CAQH estimates that VeriFide will return 98 percent of initial provider files within 14 days, with an accuracy and completeness rate of 98.5 percent. 

Once the data has been analyzed and confirmed, and before it is forwarded to health plans, the system categorizes each data element based on the verification results. This enables the plan to automatically route the provider files requiring special follow up, further speeding the credentialing process.

To achieve the goal of industry-wide sharing of validated provider data and the related cost benefits, the credentialing dates of healthcare providers need to be aligned across health plans. Currently, each plan credentials providers on its own unique three-year cycle. Using a sophisticated scheduling algorithm, VeriFide will make gradual changes to provider credentialing dates over time to reach this shared provider "anchor date." This ensures health plan operations experience little disruption during this transition.

"The launch of VeriFide further demonstrates CAQH leadership in addressing industry needs for accurate, timely provider data," said Robin Thomashauer, CAQH Executive Director. "It builds upon our existing expertise and, like our other solutions, offers a collaborative, cost-effective way to reduce the administrative burden on providers and plans alike."

To learn more about this CAQH initiative, visit CAQHVeriFide.org.

About CAQH
CAQH, a non-profit 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. Visit www.caqh.org for more information.


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