Web-based physician credentialing system seen as time-saver

Yet some doctors said the service is still too complicated, and they are not sure which health plans participate in it.

By Damon Adams — Posted Aug. 2, 2004

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Maryland internist Howard Lanham, MD, has plenty to deal with: lower reimbursements, rising liability insurance rates and the rigors of running a solo practice. He doesn't have time to fuss with a lot of paperwork.

Getting credentialed with health care organizations used to require filling in stacks of applications -- one application per health plan -- and copying licenses and certificates to accompany each form. "If you're talking about 30 pages per 12 health plans, that's a lot of time," said office manager Marty Lanham.

Dr. Lanham has found an easier way. He now uses the Universal Credentialing DataSource, a Web-based system that allows Dr. Lanham and other physicians to submit their credentials in a single application to meet the credentialing requirements of participating health plans.

"Anything we can do to be more efficient, we want to do," said Dr. Lanham, who practices in Westminster, Md.

The credentialing system was launched in March 2002 in Colorado and Virginia by the Council for Affordable Quality Healthcare, a nonprofit coalition of the nation's largest health plans and networks. Today, the service is used in 49 states (Nevada is expected to be included by the end of the year), and 40 health plans are participating, including Aetna, CIGNA and UnitedHealthcare.

More than 100,000 physicians have registered, eliminating their task of completing multiple applications for credentialing and recredentialing.

"There's no more putting an application in the mail," said Sorin Davis, chair of CAQH's credentialing, marketing and communications group.

Mixed feelings

But some physicians said the system is not perfect. If a health plan does not participate in the program, the doctor still must fill out a paper application for that plan.

Others question the service simply because it was started by health plans, and some physicians have a certain level of distrust toward health plan initiatives.

"Because it's the health plans, there's a lot of suspicion there," said Sandra Bressler, vice president of medical and regulatory policy for the California Medical Assn.

This spring the Medical Society of the State of New York surveyed members about credentialing and the CAQH system.

Some physicians said they were grateful for a universal form and supported CAQH's efforts. Others said they didn't know which health plans participated and said the process is still too complicated.

"CAQH requires updates on the process every three months -- time-consuming, onerous, redundant," one respondent said.

Health plans, hospitals and medical societies throughout the country have worked together to develop standardized credentialing forms.

Some states, such as Illinois, North Carolina and Texas, have passed laws mandating standardized credentialing.

In the CAQH system, a doctor fills out one application that goes to a central database. The application may be updated at any time by Internet or by fax.

Every three months, the doctor needs to confirm that the information is accurate. The service is free to doctors and means they don't have to submit to the credentialing process every two to three years with individual health plans.

"It's definitely better than the old system. There's a lot less paper involved and a lot less time," said Patty Tokarek, an executive assistant who handles credentialing for 48 doctors in Women's Health Partnership PC in Carmel, Ind.

The American Academy of Family Physicians supports the CAQH system and is encouraging family doctors to adopt the online service.

AAFP President Michael Fleming, MD, said the service will save time for physicians and staff and cut paperwork.

"It's a huge step forward," he said.

Physicians and health plan officials said other efforts to simplify the credentialing process have failed, but they are optimistic the CAQH service will grow.

"We have been using it very successfully," said Kim Watson, credentialing manager for Anthem Blue Cross and Blue Shield's Midwest region. "It's ultimately going to mean so much less work for the physician offices."

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On the way to universality

In March 2002, the nonprofit Council for Affordable Quality Healthcare began offering the Universal Credentialing DataSource in two states. Here is a look at who's using the Web-based system today:

  • Physicians and health plans in 49 states and Washington, D.C. Nevada is expected to join later this year.
  • 40 health plans, including Aetna, CIGNA Healthcare and UnitedHealthcare.
  • More than 100,000 physicians nationwide.

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External links

Council for Affordable Quality Healthcare (link)

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