Physician credentialing gets streamlined

The verification service promises participants less paperwork to save them time and money.

By Cheryl Jackson, AMNews staff. Aug. 19, 2002.

A Louisville, Ky., company is arranging alliances across the country that will provide insurers and hospitals with information about physicians, reducing the amount of paperwork doctors have to submit to be credentialed.

Aperture Credentialing Inc., a spin-off of Humana Inc., is building alliances based on a model that gives participating insurers and hospitals discounts. About 10 of the nation's 20 largest plans are in the alliance.

Physicians have to submit information once every three years to satisfy requirements of alliance participants. Doctors already participate in models in Connecticut, Florida, Kentucky, New York and New Jersey.

Over the next three years, Aperture plans to move the model into California, Georgia, Illinois, Indiana, Ohio and Texas.

Most insurers and hospitals want the same information from physicians, said Aperture CEO Bob Bunker. The average physician contracts with 15 to 20 health plans and admits to two or three hospitals.

The credentialing process for each plan or hospital typically requires about four hours to complete the average 30-page application, which is required every two to three years. That costs doctors about $1 billion in administrative time. "Physicians are very frustrated because it costs a lot of money and time and effort to fill out all of these," Bunker said. [...]