Physicians embrace 1-stop credentialing system

Four years ago, a system was launched in two states to help physicians meet health plans' time-consuming credentialing requirements more efficiently. Today, the credentialing program covers all 50 states and Washington, D.C,. and has attracted more than 200,000 doctors.

The Universal Credentialing DataSource service allows physicians to go online and file credentialing information for free through a single application. The form meets the credentialing needs of about 250 participating health plans, hospitals and other organizations. The service has reduced paperwork and administrative costs for physicians who used to file stacks of applications -- one per health plan --that included copies of certificates and licenses to accompany each form.

In the days of paper forms, physicians filled out as many as 17 applications for health plans, said Christopher Dooley, executive director of the Women and Infants Physician Hospital Organization in Providence, R.I. Applications were shipped to doctors, and forms piled up.

"Now we have one application that provides us with all of the information we need," he said.

The Council for Affordable Quality Healthcare, a nonprofit alliance of the nation's largest health plans and networks that started the universal system, said the program eliminates $33 million a year, or 1.1 million hours of physician and support staff time necessary to complete and send paper application forms. It based the savings on figures from a September 2004 Medical Group Management Assn. cost analysis. The CAQH estimates that the service has eliminated 900,000 credentialing applications.

"This is a free one-stop shop to submit all of their credentialing needs," said Atul Pathiyal, project director of CAQH's credentialing initiative.

The CAQH began the Universal Credentialing DataSource service in March 2002 in Colorado and Virginia, aiming to stop physicians from having to fill out multiple applications to complete the credentialing process. Today, a physician fills out one application that goes to a central database. Doctors authorize health plans and other organizations to access their information. Every three months, physicians must confirm that the information is accurate.

The service means that physicians don't have to submit to the credentialing process every two to three years with individual health plans. Health plans that use the program include Aetna, Cigna, WellPoint and UnitedHealthcare.

"Credentialing is one of the most annoying things for physicians, and frankly it's rather onerous for us as well. This [program] is really something that makes sense and whose time has come," said Barry Schwartz, MD, vice president of network management for Blue Cross and Blue Shield of Florida, which joined the initiative in December 2005.

WellPoint said 70,000 physicians in its network benefit from the universal system.

"One of our goals was to reduce the administrative burden on physician practices. It really helps physicians out. It's been an excellent example of collaboration," said Alan Rosenberg, MD, WellPoint's vice president of medical policy, technology assessment and credentialing.

Reducing paperwork hassles

Some physicians initially balked at the idea. In 2004, the Medical Society of the State of New York surveyed members about the CAQH system and found that some doctors were grateful for a universal form and supported the efforts, but others didn't know which health plans participated and said the process was still too complicated. If a health plan does not participate, the doctor still must fill out a paper application for that plan.

Several physician organizations, including the American Medical Association and the American Academy of Family Physicians, have voiced support for the CAQH system.

"This credentialing system will allow physicians to reduce the amount of time spent on the repetitious credentialing process, freeing valuable time for the important task of caring for their patients. The entire health care system benefits when administrative time and costs are reduced," AMA Board Chair Duane M. Cady, MD, said last year.

Health plans have seen time benefits, too. Capital District Physicians' Health Plan, based in Albany, N.Y., said the CAQH system had shaved five days off the previous 60-day process of receiving and reviewing a doctor's application.

"It's much, much easier. The redundancies in the process have been streamlined tremendously," said Lisa Baum, who manages Capital District's credentialing.

In addition to CAQH's program, health plans, hospitals and medical societies have worked together to develop standardized credentialing forms to make the process easier. Some states, such as Illinois and Texas, passed laws mandating standardized credentialing.