Transcript Lynette Rhodes - Care Management Com. Mtg 4.9.14

Centralized Provider Credentialing
Verification Organization (CVO)
Presentation to: Care Management Committee
Presented by:
Lynnette Rhodes, Deputy Director
Contract Compliance and Resolution
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Mission
The Georgia Department of Community Health
We will provide Georgians with access to
affordable, quality health care through
effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
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Centralized Credentialing Verification
Organization (CVO)
• DCH pursuing a centralized provider credentialing
and re-credentialing function through the Medicaid
and PeachCare fiscal agent, HP
• Purpose of a centralized CVO is to ease
administrative burdens on the providers
• Providers will be credentialed by HP and their
subcontractor for FFS and CMO providers
• CMO will delegate credentialing to HP
• Expected implementation: July 2015
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Old Process
Applies
4 Times
FFS
Amerigroup
Wellcare
Enroll
Credentialing
Credentialing
Credentialing
Credentialed 4
Times
Enroll
Contracting
PeachState
Credentialing
Enroll
Enroll
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Improved Process (Implemented March 2013)
Applies
Once
FFS
Credentialing
Credentialing
PeachState
Credentialing
Wellcare
Single Enrollment
Portal
Credentialing
Credentialed 4
Times
Enroll
Contracting
Amerigroup
Enroll
Enroll
Enroll
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Future Process (Targeted 7/1/2015)
Applies ONCE
Enroll
FFS
Enroll
AMGP
Contracting
Credentialing
Verification
Organization
(CVO)
Enroll
PSHP
Enroll
WCG
Credentialed ONCE
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CVO Advantages
• Advantages
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Administrative simplification
Single, electronic application process
Providers credentialed once
Consistency in credentialing process and decisions
Synchronized re-credentialing process and cycles
Provider ability to track application/credentialing status
Direct DCH ownership of credentialing process
Financial advantage
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Questions?
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