Credentialing hassles may become a thing of the past
Recent innovations are likely to cut paperwork
If filling out credentialing forms for numerous managed care organizations is one of your practice’s biggest paperwork nightmares, you soon may be able to rest easier. Consider these recent announcements:
• Three of the nation’s largest managed care organizations have joined to develop a universal application to credential medical providers for their networks.
• Aperture Credentialing, the nation’s largest credentials verification service, has introduced an on-line application process for physicians it credentials.
• An automated credentialing form that eliminates the need to fill out multiple applications has been developed by Caredata.com, a provider of health care content on the Internet. The application is included on the Web site Physiciansite.com, an Internet portal site for physicians.
Physician practices have long complained about the time involved in filling out credentialing applications to become a part of managed care networks. Some practices contract with as many as 15 managed care plans, all of which have different forms for gathering what is essentially the same information. Because the credentialing process must be repeated every two years, the paperwork burden can become onerous.
"In the past, each health plan had a different twist to their application. For the provider, it was nothing but a headache," comments Kathy Welter, manager of corporate communications for Aperture Credentialing, a Louisville, KY, verification firm.
Aperture has announced the introduction of App-One.com, a Web site where practitioners can store and update their credentialing information in one secure location. The Web site uses encryption technology to ensure that all data are kept secure and confidential, Welter says.
App-One is an extension of Aperture’s universal application, recently implemented by Humana, Oxford Health Plans, and UnitedHealthcare for physicians who want to be part of the three MCOs’ medical networks.
"Many doctors have too much paperwork, leaving too little time for what matters: their patients. By honoring one set of paperwork, we can lighten part of that load for physicians, allowing them more time to deliver care," says Lee Newcomer, MD, senior vice president of health policy and strategy for UnitedHealthcare’s parent company, UnitedHealth Group.
The universal application doesn’t mean physicians who meet the criteria of one health plan will automatically be accepted by the others, notes Pam Atherton, chief executive officer of Aperture.
"Each company will apply its own participation criteria and make its own decision about whether to add a physician to its network, " she adds.
Humana’s chief medical officer, Jerry Reeves, MD, calls the cooperative agreement "unprecedented. Everybody wins with this type of arrangement. Doctors with less paperwork can deliver more personalized care to patients, and a single process means greater efficiency for health plans," he says.
Any practice in the Aperture database can fill out the App-One information and submit it on-line, then print it out, sign it, and submit it to any other health plan, Welter adds.
Meanwhile, Caredata.com has introduced appStat, a Web-based application that provides on-line access to credentialing applications. Providers fill out a single form one time and then choose from a list of health plans to which they want to submit the application.
The Caredata.com program automatically produces the proper credentialing form, based on which health plan will receive it.
"Health plans all ask for essentially the same credentialing information, but it’s in a gazillion formats. All they have to do is fill out the appStat form once, and it will produce the form based on where it’s being sent," says Andrea Kofl, RN, chief operating officer for Physiciansite.com.
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