Guidelines for health care network apply to all
Credentialing hits private duty
If you provide private duty services for a larger health care company, be prepared for a few changes. Companies such as Olsten Health Services are now requiring that all their providers, home health and otherwise, go through the same credentialing process.Providers in the Olsten Health Services Network used to be credentialed on the state level. Now they will be credentialed through a national committee of health care professionals. (Private duty services are grouped under the home health umbrella.) Olsten Health Services, a subsidiary of Olsten Corp. and based in Melville, NY, operates about 600 health care offices in the United States and Canada. In 1996, the company provided services to more than 400,000 client/patient accounts.
The committee will develop guidelines for providers that meet and exceed standards set by the National Committee on Quality Assurance (NCQA), say Olsen executives. NCQA is an independent, Washington, DC-based not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, including HMOs.
Convenience was the primary reason for shifting the credentialing process to one national committee, says Marlene Burchell, LPN, CPHQ, credentialing manager for Olsten Health Services Network.
"We were establishing committees in all the states in which we had providers," she explains. "It was difficult not only to recruit the type of members [for the committees] that we wanted, but also to schedule the meetings and make sure we got the credentialing basis for the payers."
While considering a solution to the scheduling difficulties, Olsten decided to expand the scope of its credentialing. "We wanted to start credentialing more providers than just the norm — more than the traditional nursing that was required by the NCQA. We found it would be difficult to develop a policy and have to take it through the committees based on the different states we had."
Olsten, therefore, decided to develop a national committee composed of members from different parts of the country and from different health care specialties. The committee now holds 20 members. Ten of the 13 members external to Olsten are physicians. Several also are medical directors.
"We wanted to have a team of experts with which we could develop a policy," says Burchell. "We made it so we would have representation from all across the country in every specialty that we could possibly want."
How the process has changed
Providers that have already gone through the Olsten credentialing process on the state level and obtained committee approval won’t see a lot of changes, Burchell says. The application, however, will be more user-friendly and will target more specifically the questions for each individual provider type."Before, we had about 110 questions we sent to every provider regardless of what provider type they were," she explains. "The providers had to go through and mark every question that was applicable to them."
Now Olsten has one application that everyone fills out. Then a section is added that asks specific questions about the provider type. (For more information about Olsten’s overview of credentialing items, see related story, above.)
Providers won’t see a lot of difference in the process, with the exception that the change to a national committee should speed things up, she says. Once the signed applications are received in credentialing department, it typically takes 45 to 60 days to get the file completed and get all the information to the committee. "[With the national committee], we should get providers into the network a lot quicker, get them credentialed, and get them an approval so they can start seeing patients."
The committee meets monthly, primarily through monthly conference calls, although they do have a face-to-face meeting twice a year. "All the committee members are available and dedicated to a certain time every month," Burchell says. "You don’t have to go through the rigmarole of having to schedule various committees in every state."
The committee also is not limited to how many applications it can review. The conference calls last about two hours," Burchell says. "We’ll bring everyone together, and if we need to expand the meeting time, that’s no problem."
Although provider panels at Olsten are full in many major cities, the company may be accepting new providers as contracts open up, Burchell says. "It depends on the region of the country."
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