CAQH announces plan for credentialing system
Pledging to ease physician paperwork, The Coalition for Affordable Quality Healthcare (CAQH) in Washington, DC, announced plans to launch a credentialing application system that it says will be dramatically simpler than existing systems and reduce paperwork for health care providers, health plans and hospitals.
CAQH is a nonprofit coalition of health care organizations founded by 26 of the nation’s largest health plans and insurers covering more than 110 million Americans. H. Edward Hanway, chairman and CEO of CIGNA and chairman of CAQH, says the CAQH system will gather and store detailed data from more than 600,000 providers nationwide. These electronic records will be available anytime to authorized health plans and hospitals without requiring cumbersome paperwork and delays.
This initiative, to be launched in the spring of 2002, is the first phase of CAQH’s broad multi-year plan to simplify not only the credentialing process, but also other administrative processes in the health care industry, says Jay Gellert, president and chief executive officer, Health Net, and chair of the Administrative Simplification Committee for CAQH.
"One of the most time-consuming tasks facing providers and payers is the paperwork associated with credentialing," Gellert says. "As part of our ongoing commitment to improving the health care experience, CAQH is reducing administrative hassles for providers across the country, giving them more time to focus on what’s important: their patients."
A typical provider contracts with 10 to 20 health care organizations, each of which requires the provider to complete an extensive credentialing application. Using the CAQH system, each provider will submit a single application to one central database to meet the needs of all of the health plans and hospitals participating in the CAQH effort.
Providers may easily update their information on-line or via fax anytime, and will confirm once each quarter that the data on file are complete and accurate. During the course of the roll out, CAQH will invite health plans, hospitals, and related organizations nationwide to utilize these data to maximize the benefits of the system for the entire health care industry.
Organizations are not required to join CAQH to subscribe to the CAQH credentialing data system. Previous efforts to create a shared system for credentialing data have been limited to individual states, have appealed only to part of the health care industry, or simply lacked the technology available today.
Marjorie O’Malley, senior vice president for CIGNA and chair of CAQH’s Credentialing and Provider Directory Work Group, says the CAQH system is designed to support the entire health care industry.
"CAQH is not a business; it is a not-for-profit coalition that enjoys the support of 26 of the nation’s largest health plans and key trade associations," O’Malley says. "CAQH continues to gather input from organizations representing health care providers, health plans, hospitals, and even state legislatures to ensure that this system will meet the industry’s needs. Each organization will continue to make its own credentialing decisions, but we will reduce the cost and hassle of managing up-to-date provider data."
CAQH development teams have agreed on a common set of required data and have incorporated state-adopted application forms where appropriate to provide a universal solution for providers and organizations nationwide.
Beginning in the summer of 2002, the system will become available to providers nationwide.
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