The Council for Affordable Quality Healthcare is a non-profit alliance of health plans and trade associations, working to simplify healthcare administration through industry collaboration on public-private initiatives. CAQH strives to be a catalyst for industry collaboration on initiatives that simplify healthcare administration for health plans and providers, resulting in a better care experience for patients and caregivers.
Through two initiatives -- the Committee on Operating Rules for Information Exchange (CORE) and Universal Provider Datasource (UPD) -- CAQH aims to reduce administrative burden for providers and health plans. These solutions promote quality interactions between plans, providers and other stakeholders; reduce costs and frustrations associated with healthcare administration; facilitate administrative healthcare information exchange; and encourage administrative and clinical data integration.

Members

CAQH members work together to create and refine initiatives for streamlining healthcare administration. Aetna

Aetna

Aetna, Inc. is an American health insurance company, providing a range of traditional and consumer directed health care insurance products and related services, including medical, pharmaceutical, dental, behavioral health, group life, long-term care, and disability plans, and medical management...

, America’s Health Insurance Plans, AultCare, the BlueCross BlueShield Association

Blue Cross and Blue Shield Association

The Blue Cross Blue Shield Association is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans. The history of Blue Cross dates back to 1929, while the history of...

, Blue Cross Blue Shield of Michigan, BlueCross BlueShield of North Carolina, BlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee is the largest health benefit plan company in Tennessee. It is an independent, not-for-profit organization governed by its own board of directors.-General information:...

, CareFirst BlueCross BlueShield, Cigna

CIGNA

Cigna , headquartered in Bloomfield, Connecticut, is a global health services company, owing to its expanding international footprint and the fact that it provides administrative services only to approximately 80 percent of its clients...

, Health Net

Health Net

Health Net, Inc. is among the United States of America's largest publicly traded health insurers. The company’s HMO, POS, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.6 million individuals in all 50 states and the District of Columbia through group,...

, Horizon Blue Cross Blue Shield of New Jersey, Kaiser Permanente

Kaiser Permanente

Kaiser Permanente is an integrated managed care consortium, based in Oakland, California, United States, founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield...

, UnitedHealth Group

UnitedHealth Group

UnitedHealth Group Incorporated is a diversified health and "well-being" company. Headquartered in Minnetonka, Minnesota, UnitedHealth Group offers a spectrum of products and services through two operating businesses: United Healthcare and Optum. Through its family of subsidiaries and divisions,...

 and WellPoint

WellPoint

WellPoint, Inc. is the largest health plan company in the Blue Cross and Blue Shield Association. It was formed when WellPoint Health Networks, Inc. merged into Anthem, Inc., with the surviving Anthem adopting the name, WellPoint, Inc...

are among the health plans and trade associations that contribute to CAQH solutions.

Initiatives

CAQH is working to achieve its administrative simplification goals through two main initiatives: the Committee on Operating Rules for Information Exchange (CORE) and Universal Provider Datasource (UPD).

Committee on Operating Rules for Information Exchange (CORE)

A multi-phase initiative, created in 2005, CORE is a committee of more than 120 industry leaders who help create and promulgate a set of voluntary business rules focused on improving physician and hospital access to electronic patient insurance information before, during, and after the time of care. CORE participants maintain eligibility and benefits data for more than 150 million commercially insured lives, or approximately 75 percent of the commercially insured, plus Medicare and Medicaid beneficiaries.

Universal Provider Datasource (UPD)

Built around a single electronic form and secure database, UPD enables healthcare providers to submit, store, update and access their most critical information for credentialing, claims processing, quality assurance and member services, such as directories and referrals. Health plans authorized by providers participating in UPD can electronically download the information into their systems. This standard form meets the data-collection needs of health plans, hospitals and other healthcare organizations.

More than 890,000 providers in all 50 states and the District of Columbia and over 550 health plans, hospitals and other healthcare organizations currently use the service to streamline data-collection processes.