Expediting the Credentialing Process Geisinger Health Plan Adrienne Bingaman, Provider Data Analyst Geisinger Health Plan October 10, 2013 Geisinger Health Plan 1

The Challenge Laws, regulations, and accreditation standards increasingly require Health Care Organizations to carry out the same level of credentialing that hospitals have long been required to carry out. Accrediting Organizations (NCQA, CMS, DOH) GHP Internal Credentialing Criteria Health Care Organizations have found themselves changing the way in which they do credentialing in order to respond to the demands of the constant changes in the health care industry. Geisinger Health Plan 2

Meeting Expectations Due to the ongoing changes of Health Reform, and in order to foster business growth, in January 2013, GHP made the decision to supplement our internal credentialing resources with the use of a Credentialing Verification Organization(CVO).. Geisinger Health Plan 3

The Process GHP’s Credentialing Process: The Council for Affordable Quality Healthcare (CAQH) Universal Provider Datasource is GHP’s standard credentialing application. Requests for Credentialing are facilitated by Provider Relations Representatives. Standard turnaround time is weeks. GHP’s Credentials Committee meets on a monthly basis (3 rd Monday of each month). Geisinger Health Plan 4

The Process Provider Relations Representative will need: Full Name and Title (Degree) of applicant Date of Birth Provider NPI CAQH Number Geisinger Health Plan 5

The Process GHP’s internal process includes: Pre-Screening the provider’s application to ensure current attestation and accessibility. Transmitting CAQH application the CVO via secure FTP site. Reviewing credentialing verifications from CVO upon return of application. Reviewing provider profile for compliance with GHP credentialing criteria, and accrediting body standards. Presenting provider profile to the Credentials Committee. Updating provider database and directory to reflect valid start dates. Notifying provider, in writing, of acceptance to GHP’s network. Geisinger Health Plan 6

Tips and Tricks Providers should update Attestation every 60 days. Offices should establish a regular review and update process for Demographic, Specialty, and Insurance Information. Always ensure application is updated with copies of requested documentation. Responding to credentialing requests from GHP or other credentialing organizations in a timely fashion is key to a quick turnaround! Geisinger Health Plan 7