0 Presentation to: Care Management Committee Presented by: Lynnette Rhodes, Deputy Director Contract Compliance and Resolution Centralized Provider Credentialing Verification Organization (CVO) April 9, 2015

1 Mission The Georgia Department of Community Health We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.

2 Centralized Credentialing Verification Organization (CVO) DCH pursuing a centralized provider credentialing and re-credentialing function through the Medicaid and PeachCare fiscal agent, HP Purpose of a centralized CVO is to ease administrative burdens on the providers Providers will be credentialed by HP and their subcontractor for FFS and CMO providers CMO will delegate credentialing to HP Expected implementation: July 2015

3 Old Process FFS Amerigroup PeachState Wellcare Credentialing Enroll Applies 4 Times Credentialed 4 Times Contracting

4 Improved Process (Implemented March 2013) FFS Amerigroup PeachState Wellcare Credentialing Enroll Applies Once Credentialed 4 Times Single Enrollment Portal Contracting

5 Future Process ( Targeted 7/1/2015) Enroll AMGP Enroll PSHP Enroll WCG Applies ONCE Credentialed ONCE Credentialing Verification Organization (CVO) Enroll FFS Contracting

6 CVO Advantages Advantages –Administrative simplification –Single, electronic application process –Providers credentialed once –Consistency in credentialing process and decisions –Synchronized re-credentialing process and cycles –Provider ability to track application/credentialing status –Direct DCH ownership of credentialing process –Financial advantage

7 Questions?