Transcript Document

Universal Provider Datasource:
An Industry Standard for Practitioner Data Collection
February 2009
012709
An Industry Standard for Practitioners
Nearly 690,000 unique practitioners have already registered
with and are using the system (with nearly 10,000 new
practitioners registering monthly).
700,000
680,000
660,000
640,000
620,000
600,000
580,000
560,000
540,000
520,000
500,000
Complete (with Unaffiliateds)
Jan-09
Dec-08
Nov-08
2
Oct-08
Sep-08
Aug-08
Jul-08
Jun-08
Registered (with Unaffiliateds)
A Standard that Works - Practitioner Utilization
•
Breakdown of Standard vs. Allied and Ancillary Practitioners
– Of the 690,000 registered practitioners, 476,000 are standard practitioners
and 214,000 are allied and ancillary practitioners
•
Complete practitioners and percentage with current attestation
– 626,000 practitioners have completed applications
• 76% of completed practitioners have current attestations (120 days or
less)
•
A study of UPD transactions over a 20 month period (January 2006
through August 2007) confirmed that practitioners utilize the UPD
routinely and update information frequently
– Practitioners routinely access the system
• 383,911 unique practitioners attested 1,798,729 times
• 4.7 attestations per practitioner out of a potential 5 attestations
– Update information frequently
• 1,100,031 (61%) of the attestations were accompanied by data
changes
3
An Industry Standard for Payer Organizations
Nearly 500 participating health plans, networks and other organizations,
including:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
4
Aetna, Inc.
Affiliated Healthcare, Inc. (AHI)
AmeriChoice
AmeriHealth
Anthem Blue Cross and Blue Shield
Arnett Health Plans
AultCare
AvMed Health Plans
BCBS Florida
BCBS Georgia
BCBS Kansas
BCBS Kansas City
BCBS Michigan
BCBS Missouri
BCBS North Carolina
BCBS Western New York/HealthNow
BCBS Wisconsin
Blue Cross of California
Capital District Physicians' Health Plan
Care1st of Arizona
CareFirst BCBS
CareSource
Centene Corporation
CIGNA HealthCare
CIGNA Behavioral Health
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Community Choice Michigan
Community Health Care Network
Coventry Healthcare
Deaconess Health Plans
Elder Health, Inc.
Empire HealthChoice
Excellus Health Plans
The First Health Network / CCN Network
Group Health Insurance of New York (GHI)
Great-West Healthcare
HealthLink, Inc.
Health Net, Inc.
HealthPlan of Michigan
HIP Health Plan of New York
Horizon BCBS of New Jersey
Humana / ChoiceCare Network
Independence Blue Cross
Independent Health
Kaiser Foundation Health Plan of the MidAtlantic States
Lovelace Health System, Inc.
MagellanHealth Services
MAMSI Health Plans
Martin’s Point Health Plans
Mercy Health Plans
Medical Mutual of Ohio
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Molina Healthcare
MVP Health Plan
National Capital NCPPO
OptiCare
Oxford Health Plans, Inc.
Parkview Health Plan Services
Preferred Care
Priority Health
Rocky Mountain Health Plans
Sentara Healthcare
Suburban Health Organization of Indiana
Sutter Medical Foundation of California
Synergy Health Network
Triad Healthcare
UniCare
Unified Physicians’ Network
United Healthcare
United Behavioral Health
Univera
Virginia Premier
WellCare
WellChoice
WellPoint
XL Health
An Emerging Standard for New Users and Uses
•
Hospitals starting to participate – currently 39 hospitals are using UPD
–
–
–
•
State Medicaid agencies exploring participation
–
–
•
Through the Vermont Hospital Association, its 13 members are now UPD participating
organizations
KS and RI are also considering participation through association agreements
Individual hospitals in several other states have started to participate and more are
recognizing and reviewing the UPD value proposition
PA and KY Medicaid agencies expected to sign participation agreements shortly
VA and NY Medicaid agencies reviewing participation
Emergency Responder Registries
–
CAQH is exploring the use of the UPD to enable practitioners to volunteer as Emergency
Responders and electronically forward their data to designated state ESAR-VHP registries
•
•
Practitioner Opt-In Module
–
5
CAQH is working with the Massachusetts System for Advanced Registration (MSAR) program to
use the UPD as a practitioner outreach and data collection tool for the program
Future system enhancement that will allow practitioners to elect to participate in various
initiatives or data exchanges with participating organizations – this will allow the collection
and exchange of specific additional data/information relevant to specific initiatives
An Emerging Standard for States
•
A growing number of states have addressed their local credentialing
concerns by supporting the national standard application promoted by
CAQH. These states are:
– District of Columbia, Indiana, Kentucky, Maryland, Missouri, Ohio and
Vermont: Adopted CAQH application as their own mandated form
– Louisiana, New Jersey and Tennessee: Require or allow health plans to
use either the standard CAQH application or a state-specific alternative
– Kansas and Rhode Island: Insurance Commissioners have agreed to
promote voluntary statewide adoption of CAQH application
– New York: Rejected mandating a state specific application because the
CAQH application was enjoying widespread voluntary adoption
– New Mexico and Washington: Ongoing discussions regarding CAQH
application
6