Citizens for Affordable Quality Health Care

caqh1

  • Non-profit organization comprised mainly of for-profit health insurance and health care providers
  • Promotes “industry collaboration” and “information sharing”

Council for Affordable Quality Health Care (CAQH) is a front group for health management organizations and large health care corporations which helps to promote “industry collaboration” in health care administration.  While the group claims its purpose is to “achieve a healthcare system in which administrative processes are efficient, predictable, and easily understood by patients, caregivers and providers”, CAQH’s ties to leading for-profit health care providers and insurance companies cast doubt upon this claim.  Several members of the group’s leadership have been directly tied to for-profit health insurance providers, includind H. Edward Hanway, the Chairman and CEO of CIGNA, who recently served as Chairman of CAQH.1

One of the Council’s largest initiatives is the Universal Provider Datasource (UPD), which is claimed to be “achieving its vision of simplified data collection by reducing paperwork and millions of dollars of annual administrative costs for more than 700,000 providers and over 500 health plans and networks across the United States.”2  This program was launched in 2002 and “allows registered physicians and other health professionals in all 50 states and the District of Columbia to enter their information free of charge into a single, uniform online application that meets the data needs of health plans, hospitals and other healthcare organizations. Approximately 8,000 new providers begin using the service each month. The provider data-collection service streamlines the initial application and re-credentialing processes, reduces provider administrative burdens and costs, and offers health plans and networks real-time access to reliable provider information for claims processing, quality assurance and member services, such as directories and referrals.”3

Another of CAQH’s larger initiatives is the Committee on Operating Rules for Information Exchange (CORE), which was started with the “vision of giving providers access to eligibility and benefits information before or at the time of service using the electronic system of their choice for any patient or health plan.”4 This program includes “more than 100 industry stakeholders – health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and banking industry experts that maintain eligibility/benefits data for over 130 million commercially insured lives, plus the Medicaid eligibility processed by some of the plans and vendors, e.g. Unisys, and the Medicare beneficiaries.”5 The purpose of this initiative is to:

  • Enhance interoperability between providers and payers
  • Streamline eligibility, benefits, and claim data transactions
  • Reduce the amount of time and resources providers spend on administrative functions – time better spent with patients

Corporate Membership and Participating Organizations6

A
Absolute Total Care
Accenture
ACS EDI Gateway, Inc.
ActivHealthCare
Advantage Health Plan
Advantica Eyecare
Adventist HealthCare, Inc.
Adventist Health System, Illinois
Aetna, Inc.
Affiliated Healthcare, Inc. (AHI)
Affinity Health Plan
AGMCA (Akron General PHO)
Alliance Health Partners
Alpha Care Medical Group
Always Care Benefits
America’s Health Insurance Plans (AHIP)
American Academy of Family Physicians (AAFP)
American Association of Preferred
Provider Organizations (AAPPO)
American College of Physicians (ACP)
American Health Information
Management Association
American Health Network of Indiana
American Medical Association (AMA)
AmeriChoice
Amerigroup Corporation
AmeriHealth Mercy
AmeriHealth New Jersey
Angeles IPA
Anthem Blue Cross and Blue Shield
Arcadian Health Plans
Arnett Clinic, LLC
ASC X12
athenahealth, Inc.
Atlantis Health Plan
AultCare
Availity LLC
Avalon Healthcare
Averde Health
AvMed Health Plans

B
Beacon Health Network
BlueCare Network
Blue Cross and Blue Shield Association (BCBSA)
Blue Cross and Blue Shield of Arizona
Blue Cross and Blue Shield of Florida
Blue Cross and Blue Shield of Georgia
Blue Cross and Blue Shield of Kansas
Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Massachusetts
Blue Cross Blue Shield of Michigan
Blue Cross and Blue Shield of Missouri
Blue Cross and Blue Shield of North Carolina
Blue Cross and Blue Shield of Rhode Island
BlueCross BlueShield of Tennessee
Blue Cross and Blue Shield of Vermont
Blue Cross and Blue Shield of Western New York
Blue Cross and Blue Shield of Wisconsin
Blue Cross of California
Bluegrass Family Health
Boston Medical Center HealthNet Plan
Brattleboro Memorial Hospital
Brattleboro Retreat
Bravo Health
Bridgeway of Arizona
Brighton Hospital
Buckeye Community Health Plan, Inc.

C
CalRHIO
Capario
Capital District Physicians’ Health Plan
(CDPHP)
Care1st of Arizona
CareFirst BlueCross BlueShield
Care Improvement Plus
CareMedic Systems, Inc.
CareSource Indiana
CareSource Ohio
Care to Care
Carolina Care Plan
Carolina Crescent Health Plan
Catholic Healthcare West
Cedars-Sinai Health System
Cenpatico Behavioral Health, LLC
Centene Corporation
Center Care Health Benefit Programs
Center for Health Transformation
Centers for Medicare and Medicaid Services (CMS)
CentMass
Central Vermont PHO
Childrens Hospital Medical Center (Cincinnati)
Childrens Mercy Family Health Partners
Childrens National Medical Center
CIGNA Behavioral Health
CIGNA HealthCare
Citrus Healthcare
Claredi (an Ingenix Division)
Clarian Ambulatory Care Management / MMG
Clinical Practice Organization
Colonial Cooperative Care
Colorado Access
Commonwealth Family Health Plan
Community Care Physicians
Community Choice Michigan
Community Family Care Medical Group
Community Health Care Network
Comprehensive Care Management
Continuum Health Partners, Inc.
Copley Hospital
Cornerstone Alliance, Inc. (A PHO)
Coventry Health Care
Creoks Behavioral Health Services, Inc.
CSC
Culpeper PHO

D

Davis Vision
DaVita Village Health
DC Chartered Health Plan, Inc.
Deaconess Health Plans
Delta Dental Plans Association
Dental Partners of Georgia, LLC
Devon Healthcare
Doctors Hospital
Doctors Hospital Nelsonville
Dublin Methodist Hospital
DuPage Valley Physicians

E

East Georgia Physician Group
Edifecs, Inc.
eHealth Initiative
Electronic Data Systems (EDS)
Electronic Healthcare Network Accreditation Commission (EHNAC)
Electronic Network Systems, Inc. (ENS) (an Ingenix Division)
Emdeon Business Services
Emerging Health
Empire HealthChoice
Employee Health Systems
Enclarity, Inc.
Excellus Health Plans
EyeMed Vision Care

F

Fairpay Select Health
Fallon Community Health Plan
FEI Behavioral Health
Fidelis Secure Care
First Choice PHO
First Data Corp. – Healthcare 1st Medical Network
Fletcher Allen Healthcare
Foresight Corporation
Freedom Healthcare
FrontPath Health Coalition

G

Gateway EDI
GE Healthcare
Geisinger Health Plan
General Vision Services (GVS)
George Washington University Medical Faculty Associates
Georgetown University Hospital
Gifford Medical Center
Gordon PHO
Goshen General Hospital / Indiana Lakes MCO
Grace Cottage Hospital
Grady Memorial Hospital
Grant Medical Center
Greater New York Hospital Association (GNYHA)
Greater Rochester IPA (GRIPA)
Great Lakes Health Plan
Great-West Healthcare
Group Health, Inc.
Group Health Insurance of New York (GHI)

H

Hardin Memorial Hospital
Harding Hospital
Harvard Pilgrim HealthCare
Health Alliance of the South
Health Alliance Plan
Health Care Service Corporation
Health Level 7 (HL7)
Health Net, Inc.
Health Net Federal Services, LLC
Health One Alliance / Alliant Health
Health Options, Inc.
Health Plus PHSP
Health New England
Healthcare Administration Technologies, Inc.
Healthcare Association of New York State
Healthcare Billing and Management Association
Healthcare Financial Management Association (HFMA)
Healthcare Information and Management Systems Society (HIMSS)
Healthcare Partners Medical Group
HealthFusion, Inc.
HealthLink, Inc.
HealthNow New York, Inc.
HealthPlan of Michigan
HealthPlus of Michigan
HealthRight
HealthSmart Preferred Care (The Parker Group)
Highmark Blue Cross Blue Shield
HIP Health Plan of New York
HMS
Hollywood Presbyterian Medical Group
Horizon Blue Cross Blue Shield of New Jersey
Hospital for Sick Children
HSC Health Plan
Hudson Health Plan, Inc.
Humana Inc. / ChoiceCare Network
Humana Vision
Huron Valley Healthcare

I

Independence Blue Cross
Independent Health
Independent Practice Association of Georgia, Inc.
Indiana Pro Health Network
Indiana University / University Health Care Associates
Industry Buying Group
Inland IPA
InstaMed
Interplan Health (The Parker Group)

J

James Cancer Hospital and Solove Research Institute

K

Kaiser Foundation Health Plan of the Mid-Atlantic States
Kaiser Health Foundation of Georgia
Kent County Health Services
Kentucky Division of Medicaid Services
Kentucky Medical Services Foundation, Inc.
Kentucky Orthopedic Physical Therapy Network
Kentucky Orthopedic Rehab Team, LLC
Keystone Mercy Health Plan

L

LaSalle Medical Associates
Lewis – Gale Clinic, LLC.
Lifespan / New England Physician Network
LINXUS (initiative of GNYHA)
Louisiana Medicaid – Unisys
Lovelace Health Plan

M

Magellan Health Care, Inc.
MagnaCare Health Plan
Maine Network for Health
MAMSI Health Plans
Managed Health Network
Managed Health Service
Marion General Hospital
Martin’s Point Health Care
Mayo Clinic
MDI
MD On-Line, Inc.
MDWise Select Health
MedData
Medical Group Management Association (MGMA)
Medical Informatics Engineering, Inc.
Medical Mutual of Ohio
Mercy Care Plan
Mercy Health Plans
Mercy Health System PHO
Meriden – Wallingford IPA
Meridian Health Plan
Michigan Department of Community Health
Michigan Public Health Institute
Microsoft Corporation
MidCounty IPA
Minnesota Department of Human Services
Mobility Medical, Inc.
Molina Healthcare of California
Molina Healthcare of Florida
Molina Healthcare of New Mexico
Molina Healthcare of Ohio
Molina Healthcare of Utah
Molina Healthcare of Washington
Montefiore Medical Center of New York
mPay Gateway
Mt. Ascutney Hospital
Multicultural Primary Care
Medical Group
MultiPlan, Inc.
MVP Health Plan, Inc.

N

NACHA – The Electronic Payments Association
National Account Service Company (NASCO)
National Capital Preferred Provider Organization (NCPPO)
National Committee for Quality Assurance (NCQA)
National Council for Prescription Drug Programs (NCPDP)
National eHealth Collaborative
NaviNet
Neighborhood Health Plan
Netwerkes
Network Health Plan
New Avenues, Inc.
New Directions Behavioral Health
New York-Presbyterian Hospital
New York Presbyterian System Select Health
NextGen Healthcare Information Systems, Inc.
NJ Shore (WEDI/SNIP NY Affiliate)
NoMoreClipboard.com
North Country Health System
North Shore Long Island Jewish Health System
North Shores Hospital
North Texas Specialty Physicians
NorthWest Georgia Physicians Association
Northwestern Medical Center

O

Ohio State University Hospital
Ohio State University Hospital East
OhioHealth Group, Ltd.
Omega Technology Solutions
OptiCare Eye Health Network
OptumHealth Care Solutions – Physical Health
Oregon Department of Human Resources
Otis Health Care Center / Grace Cottage
Owensboro Community Health Network
Oxford Health Plans, Inc.

P

Palladian Muscular Skeletal Health
Parkview Health Plan Services
PartnerCare Health Plan, Inc.
Passport Health Communications
Passport Health Plan
Payerpath, a Misys Company
Peach State Health Plan
Pediatrix
People’s Health
Physician Associates of Middle Georgia
Physician Healthcare Network, PC
Physician Organized Healthcare System
Physicians Health Plan of Mid Michigan
Physicians Health Plan of Northern Indiana, Inc.
Physicians of Coastal Georgia
Physicians United Plan, Inc.
Pillsbury Winthrop Shaw Pittman LLP
Porter Hospital
Planned Parenthood of Metropolitan Washington DC, Inc.
PNC Bank
Post-N-Track
Preferred Care Partners (Florida)
Preferred Health Professionals
PricewaterhouseCoopers LLP
Principal Financial Group
Priority Health
Prism Health
Private Sector Technology Group
Providence Hospital
Providence Park Hospital

Q

QS/1 Data Systems

R

RealMed Corporation
Recondo Technology, Inc.
RelayHealth
Richard M. Ross Heart Hospital
River District Hospital
River Valley Health Alliance
Riverside Methodist Hospital
Rochester Community IPA, Inc.
Rocky Mountain Health Plans
Rutland Regional Medical Center

S

Saint Barnabas – Metrowest IPA
Schaller Anderson
Secure EDI Health Group, LLC
Select Health
Senior Whole Health, LLC
Sentara Healthcare
Siemens / HDX
SIHO Insurance Services
Smart Card Alliance Council
South Georgia Physicians Association, LLC
Southern California Childrens Health Network
Southwestern Vermont Medical Center
Space Center IPA
Spectrum Laboratory Network
Springfield Hospital Vermont
St. Francis Health Network
St. Francis PHO
St. Francis PHO of Connecticut
St. John Macomb Oakland Hospital
St. John’s Health
St. Louis University Hospital
Stark Regional PHO
Suburban Health Organization
SummaCare
Summit Medical Group
Sunshine State Health Plan
Surescripts
Sutter Medical Foundation
Synergy Health Network, Inc.

T

Target Clinics
Texas Professional Healthcare Alliance
The Chiropractic Association of
the Midwest
The First Health Network / CCN Network
The Physicians Assurance Company
The SSI Group, Inc.
The TriZetto Group, Inc.
TRIAD Healthcare, Inc.
TRICARE
Tufts Health Plan

U

UniCare
Unified Physician Network
Unison Health Plan
United Behavioral Health
United Physicians
United States Army National Guard
United States Department of Veterans Affairs
UnitedHealth Group
Unity Healthcare
Univera
Universal American
Universal Health Care
University Healthcare Associates, Inc.
University Health Plans Inc.
University Physicians Associates Louisville
University Physicians, Inc. (University of Maryland)
UNMC Physicians
US Family Healthplan / St. Vincent
Catholic Medical Centers
Utah Health Information Network (UHIN)
Utilization Review Accreditation
Commission (URAC)

V

Valley Health
Valley Health Network
Virginia Health Exchange Network
Virginia Premier
VisionShare, Inc.
Visiting Nurse Service of New York / VNS Choice

W

Wake Forest University Health Sciences
WellCare
WellChoice
WellPoint Behavioral Health
WellPoint, Inc.
Windsor Health Plan
Wise Provider Networks
Women and Infants PHO of Rhode Island
Work Group for Electronic Data Interchange (WEDI)
Workers Compensation Trust

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3 comments for “Citizens for Affordable Quality Health Care

  1. Kenneth Arpin
    November 6, 2009 at 5:21 pm

    Where on the internet can I find the TV spot which depicts a husband moving boxes to a small apartment and later visiting his wife in the hospital and concludes with the message that no one should lose everyting because they don’t have healthcare (or words to that affect?)

  2. February 25, 2011 at 10:58 pm

    We urge that you remove any showing of credibility of this listing. It is a shame. Today the web administrator for caqh.org advertises their own domain name is for sale. Based on forensic investigation of Council for Affordable Quality Healthcare (CAQH), we characterize it as a highly dubious group administrator. Based on theft of our website identity by caqh.org and the necessity to go to bat to restore our independence, we urge that the US Attorney General investigate any and all persons at caqh.org as well as CIGNA and similar affiliates.

    If identity theft occurred at the hands of this Council, it can happen up and down the business chain. Please do further examinations of Chris McNamara, Drums, PA 18222 Tel 570.708.8780

  3. March 10, 2013 at 12:21 pm

    What I find troubling aout CAQH is that they seem to pretend they are “non-profit” when in fact I believe their website in one place accurately states “not for profit” – these are two different things. Non profit is not allowed to make a profit. Not for profit is organized without profit as its primary purpose. So. Where is all the money going? If 1,000,000 providers have been forced to sign up, how much revenue does CAQH take in, and how much are the executives and other pocketing? By requiring physicians to provide way more data about their practice than even the states require, I would be fairly certain that the insurers are ONLY going to use this information to avoid paying out to the provider. Hence- more profits for the insurer, fat bonuses for insuance exec, and of course money in the bank for CAQH. Not sure how that helps the patient. Not sure how making the physican recertify their credentials THREE TIMES a year makes sense. Since all physicians ALREADY provide credential data to their respective states, the correct approach to the credential issue would be for the feds to require all states to store this data in the same format, and to make it available electronically in a merged database- NOT to create a PRIVATE database for the money makers to use for their own pesonal for profit indulgences.

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