Credentialing SOS CAQH provides administrative relief

by Sorin Davis, Chair, CAQH Credentialing Marketing and Communications Committee

Healthcare providers commonly complain about the enormous amount of paperwork that accompanies the practice of medicine. The credentialing process is no exception. In response to this problem, the Texas Department of Insurance has adopted a uniform credentialing application for use statewide. This form was based on one developed by the Council for Affordable Quality Healthcare, a not-for-profit alliance of many of the nation’s leading health plans and networks.

CAQH has launched the Universal Credentialing DataSource, a free Web-based technology solution that promises to eliminate redundancy from this time-consuming administrative task. Using the Texas-approved form, this service further streamlines credentialing by allowing providers to submit their information only once and provide periodic updates to satisfy the credentialing requirements of all participating healthcare organizations.

To raise awareness of the availability of Universal Credentialing DataSource in Texas, CAQH mailed registration kits to physicians. Physicians who are affiliated with a participating health plan, but who have not received the kit, can call the CAQH Help Desk at 888-599-1771 or call their health plan directly.

Here’s how the CAQH Universal Credentialing DataSource works:

• Universal Credentialing DataSource is fully compliant with Texas’ Standard Credentialing Application Form regulations.
• Providers submit one set of information to a secure, uniform system that meets the credentialing needs of all participating healthcare organizations.
• The system is HIPAA-compliant and uses 128-bit SSL encryption to provide complete security.
• Providers control which healthcare organizations can access their information through a specific authorization process.
• An Administrator’s Module allows office staffs to enter data that is common to multiple providers within their practices (eg, clinic name, address, phone number) only once.
• Information can be submitted on the Web or by fax.
• Providers can update their information any time, and are prompted via quarterly e-mails to confirm that the data on file is complete and accurate.

In addition to saving providers time and aggravation, Universal Credentialing DataSource addresses data integrity. Under the current system, providers typically must undergo the credentialing or recredentialing process with each health plan once every three years, and information does not always remain current. With Universal Credentialing DataSource, providers or their office staffs spend just a few minutes each quarter to confirm that information is complete and accurate.

CAQH maintains data collected through Universal Credentialing DataSource in a secure, state-of-the-art data center. Physicians authorize which healthcare organizations can receive their credentialing information. Once authorized, these organizations have access to the credentialing information at any time. Each healthcare organization continues to review and verify credentialing data, and decides independently whether a provider meets its standards for participation.

For more information about Universal Credentialing DataSource and other CAQH initiatives, log on to www.caqh.org.