Health plan group offers one-time credentialing

Health plans want physicians to say goodbye to paperwork and hello to a central database.

By Damon Adams, amednews staff. May 12, 2003.

Talk about a paper trail.

Credentialing and re-credentialing can be a paper tiger for physicians, taking hours away from patients and requiring doctors to answer the same questions on application after application after application.

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The Council for Affordable Quality Healthcare, a nonprofit coalition of the nation's largest health plans and networks, is trying to ease that burden by offering the Universal Credentialing DataSource.

The Web-based system allows doctors to submit their credentials in a single application to meet the credentialing needs of health care organizations taking part in the program. The free service to doctors keeps physicians from having to submit to the cumbersome credentialing process every two to three years with individual health plans.

7,300 doctors in Virginia and Colorado have completed the process.

"The uniform application makes their lives easier right off the bat. The plans can use this without having to bother the doctor," said Sorin Davis, chair of CAQH's credentialing, marketing and communications panel.

CAQH, created in 1999 and based in Washington, D.C., launched the credentialing system in Virginia and Colorado in March 2002. So far, 19,000 doctors in those states have registered, with 7,300 completing the process, which includes providing documentation such as a U.S. Drug Enforcement Administration certificate.

The service also is offered in Washington, D.C., and 12 other states: Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, New Jersey, Ohio, New York, Tennessee and Texas. It should be expanded nationwide by the end of the year.

"We went to doctors and said, 'What are your key issues [with credentialing].' They universally brought up the redundancy of the process," Davis said.

Using the same application

Participating in the program are 23 health plans, including Aetna, Anthem Blue Cross and Blue Shield, CIGNA HealthCare and Health Net.

"The average doctor joins 10 to 20 health plan networks. They're doing [credentialing applications] 10 to 20 times," Davis said.

The service is offered in Washington, D.C., and 14 states.

Under the universal system, a doctor fills out one application to a central database and can update the information any time by Internet or fax. Each quarter of the year, the physician needs to confirm that the data are accurate and complete.

To participate, health plans pay $3,000 annually and $4.50 per physician in their plans. Health networks review and verify the credentialing information and independently make decisions on accepting physicians.

"We're trying to make life easier for our physicians and to get all the data we need," said Marjorie O'Malley, a CIGNA senior vice president and chair of CAQH's credentialing committee.

Initially, some physicians voiced concerns about privacy, O'Malley said. CAQH said data are collected and maintained via a secure Web site. Information is made available only to plans authorized by the doctor.

"It's probably more secure than the paper policy we've all used in the past," O'Malley said.

Marlborough, Conn., family physician Mark Tuttle, MD, prefers the single application to sending numerous applications to health plans. "Doing it over and over again for multiple plans got to be a hassle," he said. "Sometimes you make a mistake, thinking, 'Oh, I filled that one out.' The problem with that, if you don't get re-credentialed, you don't get paid."

Dr. Tuttle said the universal application saves time and cuts burdens, freeing him to treat his patients. "It makes my life so much easier. It's about as good as you can get."