Reducing Administrative Burden, Improving Quality: The CAQH Approach to Provider Data Collection

National Credentialing Forum - 2008

Sorin Davis Director – CAQH Marketing and Business Development [email protected]

914-693-6934

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An Introduction to CAQH

CAQH is an unprecedented nonprofit alliance of health plans and trade associations improving health plan/provider business interaction through innovative initiatives that streamline healthcare administration.

CAQH initiatives include: • CORE – The Committee on Operating Rules for Information Exchange • UCD – Universal Credentialing Datasource

3 Problems with Traditional Credentialing Data Collection Processes • • • • •

Redundancy:

Providers are asked to complete multiple forms essentially requesting the same information.

Follow-up:

Omitted and illegible responses require significant resources and result in processing delays.

Misalignment:

Different credentialing cycles exacerbate the problem requiring providers to complete the process at different points in time.

Off-cycle updates:

Follow-up required to maintain accurate data between credentialing events so that provider directories, referral, claims and other provider and member services are effective.

Turnaround:

Providers are frustrated with time between application submission and when a decision is finally communicated.

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The Solution: Universal Credentialing Datasource®

• •

Single application. Central location. Provider Ownership.

Replace multiple plan-specific paper processes with a single, uniform data collection system Key features include: – – – Completely free for providers Providers can complete application online or via fax Conforms to exact wording of State Department of Insurance standardized credentialing applications – – Supporting documents are imaged and attached to electronic record Participating organizations can access data in electronic format at any time if authorized by provider – – Data refreshed periodically to avoid recredentialing cycle problems Updates can be made at any time and are immediately available to authorized organizations – – 128-bit Secure Socket Layer Encryption (SSL) Toll-free help desk to assist providers

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Provider Data: Credentialing And Beyond

The Universal Credentialing Datasource is designed to collect broad and robust data on providers once to accommodate multiple administrative needs for multiple healthcare organizations: • • • • • • • • • • Demographics, Licenses and Other Identifiers (including NPI) Education, Training and Specialties Practice Details Billing Information Hospital Privileges Malpractice Liability Insurance Work History and References Disclosure Questions Images of Supporting Documents SanctionsTrack ™ - Add-on module, 400 primary sources

How It Works

A B

6 Providers submit their information online (or via fax) much like online tax preparation software

C

Participating organizations retrieve provider data in their preferred format: (A) ASCII (B) XML (C) static PDF images of applications

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Universal Credentialing Datasource: Is It Working?

Provider Adoption Organization Participation Stakeholder Association Support Accreditation Organization Compliance States Support Best Practices Lewin Group Findings Future Enhancements and Directions

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Provider Adoption

Current Status

: More than 555,000 unique providers have already registered with and are using the system (more than 10,000 new providers each month).

600,000 500,000 400,000 300,000 200,000 100,000 0 Registered Providers Complete Providers

9 Participating Organizations – More than 350 including: • • • • • • • • • • • • • • • • • • • • • • • • • 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 Health Alliance Plan of Michigan 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 Mid Atlantic 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

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Stakeholder Association Support

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Accreditation Organization Compliance

The UCD collects all information required for the evaluation of practitioners.

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States Support

• • • • • IN, KY, KS, MD, RI, VT and DC have adopted CAQH's form as the state form.

TN, LA and NJ have adopted CAQH's form as an acceptable option MO, and OH are actively considering switching from their current state-mandated forms to CAQH's form MI Medicaid grant to develop single source credentialing initiative has identified CAQH application as a data collection tool PA Medicaid reviewing participation in UCD

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Findings Shared at Best Practices Conference

Participating organizations reported the following efficiencies: • • • • • • • Decreased average processing turnaround time by 8-10 days Reduced frequency of returned provider correspondence due to poor address quality from 30-40% to 6% Discontinued sending initial credentialing packets via mail to 97% of new providers Reduced legacy re-credentialing mailings by 15,000 units ($5-8 ea) - provider perspective is that need for re-credentialing is nearly eliminated Updating provider directories real-time Reallocated legacy paper credentialing application storage space Facilitating implementation of NPI

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Key Findings: 2007 Lewin Group Survey

• A recent study by The Lewin Group for CAQH identified examples of opportunities and recommendations for use of the UCD data within participating organizations outside of the credentialing function: –

Provider relations

: Daily updates result in more accurate contact information –

Accepting new patients

which UCD collects : Organizations need this information, – – –

Data integrity Data Quality:

: 120-day attestation cycle results in greater integrity Verify and Validate UCD Data Integrity and quality

Risk management

: SanctionsTrack allows them to look beyond current geographic boundaries –

Network analysis and recruitment

: Demographic information helps in examining diversity, adequate coverage of communities –

Compliance reporting

: UCD captures many data fields needed for federal and state reports

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Enhancements and Services Being Considered

• • • • • • • • Capture Type 2 (group) NPI numbers Improve Practice Administrator module to further streamline data entry Add NTIS auto feed to eliminate need for DEA registration document imaging Provide “pushed” alerts when provider documents are about to expire Develop data import capability for provider groups to bulk download provider data into UCD Work with CMS to allow UCD data to update 855 form Work with individual state Medicaid offices to adopt CAQH application and process Provider opt-in module to allow interested providers to participate in different initiatives and programs

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