Thursday, March 12, 2015

NCQA Seeks Public Comments on Changes to Its Health Plan Accreditation by APRIL 8

NCQA is asking for interested parties to submit comments regarding proposed changes to its Health Plan Accreditation (HPA) by 5:00 PM EST on Wednesday, April 8, 2015.

From NCQA:

"NCQA is releasing proposed changes to Health Plan Accreditation for public comment, including:

  • Developing a more comprehensive assessment of network adequacy and provider directory accuracy by updating existing requirements and adding new requirements in a new category of standards: Network Management. 
  • Including new requirements to strengthen NCQA’s ability to detect systematic issues related to Utilization Management. 
  • Simplifying scoring for file review elements in HPA and other accreditation/certification products that contain these elements. 

In addition to HPA standards updates, NCQA proposes policy changes to the following programs:

  • Managed Behavioral Healthcare Organization Accreditation (MBHO) 
  • Wellness and Health Promotion Accreditation (WHP) 
  • Credentials Verification Organization Certification (CVO) 
  • Health Information Products Certification (HIP) 
  • Utilization Management and Credentialing Certification (UM/CR)" 

Please click HERE for more information on the proposed changes and instructions for submitting comments.

Tuesday, March 10, 2015

CAQH Announces Updates: UPD to CAQH ProView™ Transition

From CAQH:

CAQH ProView, the next generation of the Universal Provider Datasource® (UPD), recently launched on March 2, 2015. Several resources are available to help you in the transition:

The CAQH ProView User Guides are now available
The links below provide access to each document:
  1. Providers - CAQH ProView Provider User Guide
  2. Practice Managers - CAQH ProView Practice Manager Module User Guide
  3. Participating Organizations - CAQH Proview Participating Organization User Guide
Save the Date for CAQH ProView Training
CAQH will provide online training via webinars for participating organizations throughout March. Click here to view the available dates and to register for a session.

A complete list of action items, including information for you to communicate to your providers and IT department is available on the CAQH website.

Request Roster Validation Tool and View Sample Roster Files
CAQH has developed a roster validation tool for your organization to confirm that your new roster file format meets the CAQH ProView required changes. Sample CAQH roster file now available: Please email to request the tool and to access the sample roster files.

Need More Information? 
CAQH ProView - Frequently Asked Questions is the place to find updated answers to questions about how to prepare for the launch of CAQH ProView and information about the solution's features. If you do not see an answer to your question, please email

Monday, March 2, 2015

All Healthcare Industry Eyes on the Supreme Court This Week

Beginning on March 4, the U.S. Supreme Court will hear the first oral arguments in King v. Burwell, the case that will determine the validity of federal subsidies assisting millions of American patients afford health insurance under the Affordable Care Act. Should the Court strike down these subsidies, the effects will be felt across the entire healthcare industry. Here are "5 Things to Know About the Supreme Court Case Challenging the Health Law," a report by Kaiser Health News.