Online credentialing service levels the paying field

An online physician credentialing service developed by a group of health plans and networks is expanding nationwide. The service, run by the not-for-profit Council for Affordable Quality Healthcare, allows physicians to complete a single contract form, which is accepted by all member health plans.

"The Universal Credentialing DataSource service represents the first time the health insurance industry is working collaboratively to address a key concern of physicians and other providers in a concrete and consistent way," said Sorin Davis, chair of the Universal Credentialing DataSource marketing and communications committee for CAQH.

The service was initiated to eliminate administrative redundancy and simplify the data collection process required by all managed-care organizations, hospitals, and other payers when credentialing, recredentialing, and maintaining practice information.

Universal Credentialing DataSource provides physicians, at no cost, with the ability to easily and consistently communicate practice/credentialing information through a single uniform application supported by an online system that they control, Davis said.

Currently, radiologists, like all providers, must complete multiple application forms to be credentialed by various plans, networks, and other healthcare organizations they contract with.

By taking advantage of the CAQH Universal Credentialing DataSource, radiologists can complete one application in an easy-to-use, interview-style online process that also ensures that the information provided is automatically checked for logical errors and omissions - a common problem with paper forms that leads to multiple contacts and drains staff resource.

"This system eliminates the redundancy of submitting individual forms to each contracted organization," Davis said.

Instead, radiologists can authorize which participating organizations can access their data electronically. They can also print out their completed application for use with those organizations that do not yet participate in the initiative.

CAQH has launched the Universal Credentialing DataSource in 11 markets: Colorado, Connecticut, Florida, Georgia, Illinois, Maryland, New Jersey, New York, Texas, Virginia, and Washington, DC.

"We have enrolled more than 20,000 providers and are processing nearly 500 completed applications per week," Davis said. "In some of the early launch markets like Colorado, certain health plans report that nearly 75% of their provider networks have registered with the system, with more than 50% submitting completed applications."

About 400 of the physicians enlisted in the service are radiologists, according to Davis.

CAQH intends to accelerate provider adoption of the system during the 2003 state-by-state nationwide rollout.