Credentialing made easy

Health plans have created a one-stop service. We took a look to see how well it works.

By Wayne J. Guglielmo
Senior Editor

hen it comes to credentialing, FP Mark Tuttle of Marlborough, CT, wears two hats. He's been reviewing credentialing applications for nearly two decades for a variety of health plans and provider organizations. He's also filled out more than his share of them as a partner in a large primary care group.

In both roles, Tuttle has looked forward to the day when credentialing would be less of a hassle. "I've been pleading for a long time for a universal credentialing form," he says.

This past October, Tuttle got his wish.

The Universal Credentialing DataSource system was developed by the Council for Affordable Quality Healthcare, a not-for-profit coalition of many of the nation's largest health plans and networks, in conjunction with GeoAccess, a data management company. (See "CAQH health plan members").

First rolled out early last year in Colorado and Virginia, the system (free to doctors) has since been introduced in seven other states—Connecticut, Georgia, Illinois, Maryland, New Jersey, New York, and Texas—and in the District of Columbia. By year's end, organizers hope to have it up and working nationwide.

Instead of filling out multiple applications, most of which ask for variations on the same data, doctors can now submit one "universal" form, in either electronic or hard-copy format. All connections to the database are encrypted. (For participating plans or hospitals to receive information electronically, they need to be authorized by the physician.)

"For me, the critical thing about the system is the tremendous amount of time it saves," says Tuttle. He also likes the ease of updating data electronically.

Does universal credentialing make sense for you? Will your data be safe? We took a closer look at the new service to find out.

You get two options, manual and electronic

For physicians who still like doing things the old-fashioned way, completing a paper application is relatively painless. All you do is:

• Request a snail-mail application from CAQH (888-599-1771).

• Fax the completed application to the data collection center, which converts your information into an electronic format.

• Then fax supporting documentation to the data center.

At this point, two notifications go out—one to you, indicating that your application is complete, and another to your designated health plans and hospitals, indicating that your information is ready to be retrieved.

The online alternative requires a personal user name and password, which first-time users obtain when they register. You can complete the online form using any computer with Web access.

After connecting to the system, you'll need to identify your "provider type" (MD, DO, etc.) and which state you practice in. The system then automatically leads you through the application, "pre-populating" fields with information supplied by participating health plans and hospitals. You may stop and then return to where you left off at any time.

Completed applications are automatically checked for logic errors (say your 10-digit Medicaid number is missing a number) and omissions (you've indicated you have a DEA certificate, but do not include the DEA number). But neither the DataSource system nor CAQH itself is responsible for validating the accuracy of the data you submit. So following the automatic audit, you'll need to review the application carefully yourself. Any intentional inaccuracies or omissions could jeopardize your application with hospitals and health plans.

The next step is to gather supporting documentation, and the system includes a step-by-step guide for doing this. Once you've got your papers together, you fax them to the data center, where they will be scanned and made part of the electronic record, allowing for easy retrieval when needed. You'll receive an e-mail or fax notice once your application is complete. Then, just as with the manual application, another notice will be sent alerting your designated plans and hospitals that your information is ready to be retrieved.

Doctors who need extra assistance can contact a "toll-free provider help desk." In addition, an automated phone system permits the curious to check their application status or request a fax copy of their profile.

Updating is easy, but what about security?

Ease of updating is a major benefit. "Currently, updates get submitted in a hit or miss fashion, because physicians have to remember to send them to everyone they contract with," says Sorin Davis, chair of CAQH's Credentialing, Marketing, and Communications Committee. "Now doctors can go online at any hour and make changes—and those changes are automatically communicated to authorized plans. Plans are also notified of changes electronically, so that they can update their own electronic directories and put customer service departments on notice."

But with all this online transfer of sensitive physician data, is security an issue doctors need to worry about? It's a question that's been raised by state medical societies, including Connecticut's.

"To the extent the service helps doctors get rid of credentialing hassles, we're fine with it," says Ken Ferrucci, director of government relations at the Connecticut State Medical Society. "But we just want to know that the system is secure and that doctors won't be in any jeopardy."

Advance teams from CAQH have done their best to allay such concerns. "The system is as secure as ones used in the banking industry," says Davis. "Moreover, physicians have control of the information, which can't be sold to anyone because CAQH doesn't own it in the first place."

The big challenge with the system right now, developers admit, is getting doctors to try it out. "It's been well received, but now comes the hard work of getting everyone on board," says Davis.

To find out more about the Universal Credentialing DataSource system, visit the CAQH Web site at www.caqh.org. You can also register there for news updates and to learn when universal credentialing is coming to your state.

CAQH health plan members

 

Wayne Guglielmo. Credentialing made easy. Medical Economics 2003;7:90.