CAQH CORE Approves Two-Day Rule to Accelerate Prior Authorization Process

HIT Consultant | February 06, 2020

CAQH CORE, a multi-stakeholder organization representing a broad spectrum of health plans, providers, vendors, and government entities, has voted to set two-day time limits on how quickly health plans must request additional supporting information from providers and make final determinations on prior authorization requests. With this operating rule, CAQH CORE participating organizations agreed to update requirements in the CAQH CORE 278 Prior Authorization Infrastructure Rule. The new requirements set national expectations for prior authorization turnaround times using the HIPAA-mandated standard to move the industry toward greater automation. In particular, the updated operating rule establishes maximum timeframes at key stages in the prior authorization process for both batch and real-time transactions:

Spotlight

Dr. Abraham provides patient-centered care for men, women, children, adolescents and older adults. She promotes wellness and assisting patients to develop healthy habits that will ensure a better lifestyle. She enjoys developing close relationships with her patients and regards it as an honor to know a family and care for them. She offers patient access to many great services, including same-day appointments for illnesses, physicals or preventive care.

Spotlight

Dr. Abraham provides patient-centered care for men, women, children, adolescents and older adults. She promotes wellness and assisting patients to develop healthy habits that will ensure a better lifestyle. She enjoys developing close relationships with her patients and regards it as an honor to know a family and care for them. She offers patient access to many great services, including same-day appointments for illnesses, physicals or preventive care.

Related News

HEALTH TECHNOLOGY

TELUS to Acquire LifeWorks Inc to Boost Its Employer-Focused Healthcare Offering

LifeWorks Inc. | June 20, 2022

The world’s leader in digital and in-person health and wellbeing provider, LifeWorks, announced that it has entered into a binding agreement with TELUS, a global leader in communications technology. “We have, with the assistance of our financial and legal advisors, conducted a thorough evaluation of TELUS’ proposal along with a comprehensive process focused on maximizing value for LifeWorks’ shareholders, while taking into consideration the interest of all stakeholders. We are pleased to announce this Transaction, which is an excellent outcome for LifeWorks’ shareholders, and for our clients, partners, employees and other stakeholders.” Robert Courteau, Chair of the Board “The Transaction represents an exciting new chapter for LifeWorks. The combination of TELUS Health and LifeWorks represents an unmatched opportunity to create a leader in employer-focused primary and preventative digital healthcare and wellness solutions on a global basis. Together, we will accelerate our shared vision of empowering individuals to live their healthiest lives by unifying the continuum of care through digital-first innovations, as well as our unmatched in-person care. Our two organizations also have shared values and are leading, purpose-driven organizations committed to improving the lives of people around the world. The fit for the LifeWorks team couldn’t be better.” Stephen Liptrap, President and CEO, LifeWorks LifeWorks shareholders will have the option to elect to receive C$33.00 per LifeWorks share in cash (“Cash Consideration”); or 1.0642 TELUS shares per LifeWorks share, representing share consideration of C$33.00 based on the 20-day volume weighted average price of TELUS shares on the Toronto Stock Exchange (“TSX”) ending on June 14, 2022 (“Share Consideration”); or C$16.50 in cash plus 0.5321 TELUS shares per LifeWorks share, representing 50% Cash Consideration and 50% Share Consideration (“Combination Consideration”); Elections to receive the Cash Consideration or the Share Consideration will be subject to proration to ensure aggregate Cash Consideration and Share Consideration each represent 50% of the total transaction consideration. “We look forward to welcoming LifeWorks employees and customers into our TELUS Health family. Today’s announcement will enable us to combine the respective skills and capabilities of LifeWorks and TELUS Health, creating a globally leading, end-to-end, digital-first employee preventative and mental health and wellness platform covering more than 50 million lives. Customers will benefit from our team’s steadfast focus on providing exceptional customer experiences over our world-leading broadband networks, our consolidated engineering talent that will incorporate best-in-class data platform technologies to positively impact health outcomes for employees and their families, and our significantly expanded economies of scope and scale. This includes complementing LifeWorks’ international relationships with TELUS International’s proven expertise in digital transformation and client service excellence, as well as their expansive client base and delivery teams spanning 28 countries, to extend our offerings to customers well beyond Canada. Indeed, at TELUS Health, our mission is predicated on the belief that we can build a healthier future for people around the world by leveraging the power of technology, in combination with our caring culture, to promote collaboration and efficiency, and create better health experiences across the entire health ecosystem. This is particularly crucial in the post-pandemic era, where employers and their employees are struggling with mental health and well-being concerns. In this regard, our combined organizations, guided by a shared set of values, will provide employers with simple, convenient and effective, data-driven primary and preventive care solutions for employees and their families to proactively manage their health and wellness, including their mental health, so that they can lead their healthiest and most productive professional and personal lives.” Darren Entwistle, President and CEO of TELUS

Read More

HEALTH TECHNOLOGY

Francisco Partners Launches Data Company Merative After Acquiring IBM’s Healthcare Data and Analytics Assets

Francisco Partners and Merative | July 01, 2022

The acquisition of the healthcare data and analytics assets that were a part of IBM's Watson Health business, has been completed, according to Francisco Partners, a renowned international investment firm that specializes in working with technology companies. The new standalone business, which will be owned by Francisco Partners, will be known as Merative and have its headquarters in Ann Arbor, Michigan. Merative serves clients in the life sciences, provider, imaging, health plan, employer, and government health and human services sectors by bringing together market-leading offerings that give value across the global healthcare ecosystem. “Merative has market leading products, top clients and talented leadership. With the commitment, support and deep experience of Francisco Partners, we will invest heavily in expanding the reach of these products as we continue to work with clients to improve healthcare delivery, decision making and performance.” Gerry McCarthy Paul Roma, General Manager of the Watson Health business, is slated to transition to the role of Senior Advisor to Francisco Partners. “Paul has been instrumental in driving crucial transformation of the business. His relentless focus on customers has laid a solid foundation to build on, and we thank him for his leadership,” said McCarthy.

Read More

FUTURE OF HEALTHCARE

HealthyU Clinics Reinforces Commitment to Integrative Healthcare by Collaborating with evolvedMD

Shefali Vasave | June 07, 2022

Premier collaborative and proactive care provider, HealthyU has announced a collaboration with evolveMD to boost its commitment to expanding mental health care services. The partnership will enable HealthyU to leverage the VC-backed venture evolvedMD’s expertise in behavioral health to offer innovative health care in the behavioral health space. "HealthyU's goal is to model and advance the standard of integrative healthcare, and there isn't a partner out there with a better track record to help us realize this ambition than evolvedMD. Knowing that mental health is integral to physical health, this partnership will amplify our team's ability to treat the whole patient and increase access to top-tier care in the Valley." Shane Speirs, MD, Chief Medical Officer at HealthyU Clinics HealthyU launched its first clinic in Avondale in 2021, followed by a rapid scaling and expansion with six more clinics across the Valley. Patients will be able to visit an evolvedMD licensed health professional at the HealthyU clinics starting on June 23rd, 2022. "What makes HealthyU an exceptional partner is its focus on proactive innovation in primary care. We are constantly seeking out opportunities to disrupt healthcare, and our partnership with HealthyU will enable us to disrupt from the ground up with our proven collaborative care model at their new locations. This is the first time that we can scale with a partner from the beginning, and we are looking forward to seeing how this approach allows for innovation in the integrated healthcare space." Erik Osland, Co-Founder and Managing Partner at evolvedMD

Read More