National Effort to Simplify the Credentialing Process for Physicians Launches in Georgia.

Business Editors & Health/Medical/Insurance Writers/Reporters

WASHINGTON--(BUSINESS WIRE)--Jan. 27, 2003

To ease credentialing for Georgia physicians, CAQH, the Council for Affordable Quality Healthcare, in collaboration with the Georgia Association of Health Plans (GAHP), today announced the launch of the Universal Credentialing DataSource service in the state. CAQH, a not-for-profit alliance of the nation's leading health plans and networks, developed this free service to help physicians more easily and cost-effectively provide required credentialing information to health care organizations. Registration kits for Universal Credentialing DataSource were mailed last week to physicians across the state.

For physicians, the process of regularly submitting licensing, educational and practice information to health plans, hospitals and other health care organizations is an essential, but often redundant and time-consuming administrative task. All physicians contracting with a health plan or hospital are required to periodically submit this information. It is not uncommon for a physician to contract with 10 or more health care organizations, each with a separate credentialing process.

"We're giving physicians the opportunity to significantly reduce the time and paperwork they currently dedicate to credentialing by giving them a convenient, easy-to-use system for submitting, updating and distributing all of their credentialing information to authorized, participating plans," said Susan Pickren, a member of the Georgia Uniform Credentialing Application Committee.

Universal Credentialing DataSource enables physicians to complete the Georgia Uniform Healthcare Practitioner Credentialing Application Form just one time, either online or by fax. The Georgia Association of Health Plans has endorsed the CAQH service to physicians statewide in an effort to spur the continued adoption of a single credentialing process that uses the Georgia Uniform Healthcare Practitioner Credentialing Application Form.

"We are committed to fostering positive, productive relationships between our members and physicians," said Kirk McGhee, executive director of the Georgia Association of Health Plans. "Enabling physicians to spend more time practicing medicine and less time on the credentialing process is good for everyone - especially the patients."

The CAQH Universal Credentialing DataSource service allows physicians to submit their credentialing application only once into a uniform system, and provide periodic updates, to satisfy the credentialing needs of all participating health care organizations. Each health care organization continues to review and verify credentialing data, and decides independently whether or not a physician meets its standards for participation. There is no cost to physicians to use Universal Credentialing DataSource, and information can be submitted anytime, either on the Web or by fax. On a quarterly basis, physicians are prompted via e-mail to confirm that the data on file remains current. Data is maintained by CAQH in a secure, state-of-the-art datacenter, and is only made available to health care organizations that have been authorized by each physician. Participating health care organizations are automatically notified when a physician's information changes.

Under the fragmented system that now exists, physicians typically need to go through the credentialing or re-credentialing process with individual health plans once every three years, and information does not always remain current. With Universal Credentialing DataSource, physicians or their office staffs are asked to spend just a few minutes each quarter to confirm that their information is complete and accurate. This simple process helps ensure that data remains current for credentialing and other important purposes. For instance, health care organizations can use the data to ensure that physician information is always up-to-date in their electronic and paper directories.

In addition to CAQH members, any health care organization with credentialing requirements is encouraged to participate in Universal Credentialing DataSource. Participating health care organizations pay an annual per physician/provider fee for unlimited access to completed records, in addition to a small annual administrative fee to offset system maintenance and customer service requirements.

Officials from several health plans serving Georgia, including Aetna, Blue Cross and Blue Shield of Georgia, CIGNA HealthCare of Georgia, Beech Street, MultiPlan, Great-West/One Health Plan and Private Healthcare Systems (PHCS), have been involved in developing the CAQH credentialing service. CAQH also obtained the input of hospitals, physicians, their professional associations, and national accrediting organizations.

"CAQH members are committed to improving relations with physicians by reducing abrasion points. The CAQH Universal Credentialing DataSource will dramatically simplify the credentialing process and reduce paperwork for both healthcare practitioners and health plans with which they contract," said John Watts, president and CEO for Blue Cross and Blue Shield of Georgia, Inc.

Universal Credentialing DataSource first launched in Virginia and Colorado in 2002, and it is also now available to physicians in Maryland, Washington, D.C., Connecticut and New York. CAQH plans to launch Universal Credentialing DataSource nationwide in 2003.

About CAQH

CAQH, the Council for Affordable Quality Healthcare is a not-for-profit alliance of America's leading health plans and networks, committed to improving the quality of health care and reducing administrative burdens for physicians, patients and payers. Created in 1999, CAQH member organizations today provide and administer healthcare coverage for more than 100 million Americans.

CAQH members include: Aetna, American Association of Health Plans, Anthem Blue Cross and Blue Shield, AultCare, Beech Street Corporation, Blue Cross and Blue Shield Association, Blue Cross and Blue Shield of North Carolina, CareFirst BlueCross BlueShield, CIGNA, Empire Blue Cross and Blue Shield, FirstHealth, Great-West, Group Health Cooperative, Health Insurance Association of America, Health Net, HealthPartners, Highmark Blue Cross Blue Shield, Horizon Blue Cross Blue Shield of New Jersey, Independence Blue Cross, MultiPlan, Mutual of Omaha, Oxford Health Plans, PacifiCare, Private Healthcare Systems, The Regence Group, and WellPoint.