Evan Dumas 

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co-host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton 

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user go to therapynotes.com and use promo code PCT.

 

Evan Dumas 

Hello, and welcome to Episode 617: CAQH is now DataSpring. Why Therapists Should Pay Attention.

 

Liath Dalton 

Indeed, today’s episode is a brief but super important update for therapists and practice owners who bill insurance. And as the title said, CAQH is now DataSpring.

 

Liath Dalton 

And while I think they’re trying to position it as an administrative rebrand, which on the surface sounds pretty boring, right? It’s really one of those behind the scenes infrastructure changes that is worth paying attention to.

 

Liath Dalton 

So, here is where we give credit where credit is due, which is to our wonderful friends over at The Group Practice Exchange, as they have really taken the lead in sounding the alarm for practice owners, explaining what’s changed, as well as outlining immediate steps that practices can and should take. So, shout out to The Group Practice Exchange for paying attention to this and helping clinicians understand why it matters.

 

Liath Dalton 

But we also wanted to jump on the bandwagon, so to speak, and address it from a bit of the PCT lens and perspective, because it fits into some broader trends that we are tracking and want folks to be aware of. So basically let’s give the quick rundown of what’s changed. On January 6 of this year, CAQH announced that it is now owned by 12 shareholder companies –

 

Evan Dumas 

Oof.

 

Liath Dalton 

affiliated with leading health plans.

 

Evan Dumas 

Haha.

 

Liath Dalton 

And for additional context, it was previously a nonprofit organization. So now, CAQH describes itself as a core healthcare data connector, and they manage more than 4.8 million provider data records, sourced directly from providers.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

So now it is rebranded as DataSpring powered by CAQH, and they say that their solutions include provider data management, credentialing, directory maintenance, coordination of benefits, and other crucial healthcare data infrastructure functions, so it’s moved beyond just the thing you re-attest every few months.

 

Evan Dumas 

Yeah. Yes.

 

Liath Dalton 

And for therapists who bill insurance, this platform basically sits upstream of credentialing and payer enrollment, provider directories, network participation, and the administrative workflows that determine whether your info is accurate and whether payment systems work smoothly. So it’s a big deal.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

That’s why this matters. And I want to say this is not a moment to panic. Panic is never a constructive response, right? But it is a moment to pay close attention. And the action steps that The Group Practice Exchange has recommended and emphasized that folks should be taking right away are really good ones, so I’ll sum up what those are, and then talk about the sort of bigger PCT lens as it applies to this.

 

Liath Dalton 

So the first step that they recommend is to make sure that your CAQH slash DataSpring profile is current and re-attested. Do not give the system any easy reason to create friction. Second, document any enrollment delays, directory inaccuracies, claim disruptions, or credentialing issues.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

Keep your records.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Screenshots, dates, payer names, confirmation emails, all of it. Then third, and this is where the sort of advocacy component of it comes in. Share what you are seeing with your state associations and professional organizations and other practice owners, if you are part of a practice owner network.

 

Liath Dalton 

Basically the reason for this is that patterns only become visible when folks are documenting what is occurring and communicating about it. So those are the three action steps that The Group Practice Exchange has identified and recommended, we endorse each of those as being important.

 

Liath Dalton 

And then from the PCT lens, I would add a couple more practical steps, which is really just building on and expanding that. Which is, download or save your confirmation records when you update or re-attest. Review who has access to your profile and make sure that former employees, old billing vendors, or outdated contacts are not still connected.

 

Liath Dalton 

Then, for you group practice folks, we also would really recommend having a written internal procedure for how your practice manages credentialing, re-attestation, payer enrollment records, and provider data updates. This is not something that should live in one person’s head.

 

Evan Dumas 

No.

 

Liath Dalton 

It should be systematized and documented, so that there can be sort of trackability, accountability, and continuity if the regular, sort of, responsibility holder within the practice isn’t available. That’s just always good practice in a group practice, is that there should be no single point of failure, and that whatever your core and key processes are is something that is documented in a policy and procedure so that there can be consistency in how it’s implemented and followed.

 

Liath Dalton 

But now is the time that we want to zoom out, because this is part of a bigger issue right? We’ve spent a lot of time at PCT talking about privacy, security, HIPAA, technology, and ethics and how all of those intersect. But a big part of that is a larger question underneath, which is: who owns the infrastructure that healthcare depends on?

 

Liath Dalton 

And then, really, watch carefully for any changes to terms, or data use, integrations, required workflows, or access permissions. So those are just some of the little additional details that I would add above and beyond what The Group Practice Exchange has identified as the action steps.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Because we are seeing, and increasingly so, that infrastructure is not neutral.

 

Evan Dumas 

Oh, no.

 

Liath Dalton 

Right?

 

Evan Dumas 

No. Yeah, it’s not just the tool users that need to be ethical, but the tool owners,

 

Liath Dalton 

Right. And that’s why all of this is so consequential, and why you know, for those of us who are kind of ringing the alarm bells, it is alarming.

 

Evan Dumas 

Oh, yeah.

 

Liath Dalton 

Right? Because the, the organizations that control the systems we rely on have massive influence over how care is delivered.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

How data moves, how clinicians participate, how reimbursement works, and how healthcare markets function. Like that’s huge, right?

 

Evan Dumas 

Mhm.

 

Liath Dalton 

So the whole piece of why the CAQH becoming DataSpring and being owned and managed by 12 payer shareholder groups, basically, is, is that it connects to this larger conversation that we’ve been having about therapy platforms, AI tools, payer consolidation, these practice management services that are also sort of rolled into being a therapy platform and a provider network, and where we’re just seeing kind of consolidation and monopolization of these systems by the payers, right?

 

Evan Dumas 

Mhm.

 

Liath Dalton 

So what, what we really need to be evaluating for, for every infrastructure component that we utilize or rely on, is who owns it, who governs it, who has access to the data, and whose interests are built into that system?

 

Liath Dalton 

Because the bigger overarching question is really, what happens when clinicians are dependent on infrastructure they cannot control and don’t necessarily have the ability, at least presently, to meaningfully influence? Right?

 

Liath Dalton 

So bringing it back to not being fear-mongering, looking at it from a risk management perspective. Risk management doesn’t require us to predict the future.

 

Evan Dumas 

No.

 

Liath Dalton 

But Evan, you can, you can talk in depth about that, right?

 

Evan Dumas 

Yeah, it’s just normalizing risk and preparing for it, rather than, you know, the proverbial sticking your head in the sand approach.

 

Liath Dalton 

Exactly. So the application of good risk management is to, in this context, is really to understand the systems that your practice depends on, to pay attention to incentives as they apply in this context, and document concerns when they arise.

 

Liath Dalton 

So that’s the sort of awareness that we want any providers that work with insurance to be bringing to this change, and how they interact with Data Spring going forward. And then really pay attention to how this fits into the whole healthcare infrastructure ecosystem, and make intentional decisions where you have the ability to choose between, you know, what platforms or different organizations that you are working with and affiliated with.

 

Liath Dalton 

Choice, choice matters, where, where choice is present. This isn’t an instance where there is choice, which is part of the concern, right? So, within that, being proactive where you can, and communicating what you experience, if there are concerning things with your, with your colleagues, and with other, you know, stakeholders, other providers that are stakeholders, is going to be really vital to hopefully help minimize any negative consequences or repercussions that result from this, the shift.

 

Liath Dalton 

But we always have to be looking at what, what is in it for these organizations. What is their ulterior motive, and how, how does that impact the practice landscape?

 

Liath Dalton 

So do check out, I’ll include in the show notes the link to The Group Practice Exchange’s information about this, and a couple additional news stories. But just keep it, keep an eye on things, and definitely do go through the re-attestation process and document everything.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

And we’ll, we’ll keep you updated as, as things develop, and as more, more is known.

 

Evan Dumas 

Mhm.

 

Liath Dalton 

Thanks for joining us. We’ll talk to you next week.

 

Evan Dumas 

Yeah, talk to you next week, everybody.

 

Liath Dalton 

This has been Group Practice Tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast or click podcast on the menu bar.