1. PROVIDER CREDENTIALING SYMPOSIUM LESSONS FROM THE TRENCHES OF CREDENTIALING & PROVIDER ENROLLMENT NANCY DUNN & MATHIEU GAULIN BOSTON CHILDREN’S HOSPITAL APRIL 27, 2016

2. Mission Boston Children's mission is to provide the highest quality health care, be the leading source of research and discovery, to educate the next generation of leaders in child health and to enhance the health and well- being of the children and families in our local community. We are committed to achieving and maintaining a standard of excellence in all we do. First and foremost, we consistently strive to make the patient experience a model of quality care through advanced treatment, compassionate support and full family participation and communication. As such, we have strived to make the credentialing and enrollment processes as efficient as possible to meet our mission and to remain in compliance with BORM regulations, TJC standards and NCQA standards.

3. Boston Children’s Hospital by the Numbers Boston Children’s Hospital is an acute care pediatric hospital with 399 beds. We have satellites in Peabody, Lexington, South Weymouth, Waltham and MEHC. In addition, we have network relationships with Winchester Hospital, Beverly Hospital, South Shore Hospital, and Southcoast Health. BREAKDOWN OF THE MEDICAL STAFF AND HOUSE STAFF Medical Staff = 2358House Staff = 473 Active Staff  1117 Clinical Fellows  287 Affiliate Staff  190 Interns/Residents  186 Adjunct Staff  547 Associate Scientific Clinical Staff (psychologists)  106Rotators  over 900 Associate Scientific Research Staff  398 Boston Children’s Hospital has 38 ACGME accredited training programs

4. Credentialing Process: Small Steps to Improvement Volume of initial appointments  to accept applications that are not technically “complete” 180 clock starts ticking when the authorization to release is signed, the sooner we get the application, the better Accept an application for processing while the applicant simultaneously apply for a MA medical license  why not meet at the finish line with a fully credentialed file and a MA medical license Accept an application for processing while the applicant is still in a training program* Accept an application for processing while the applicant is applying for federal and state DEA certificates  Thank goodness for the DEA Waiver in the IMA

5. Credentialing Process: Small Steps to Improvement Other common problems that can hold up the application: Malpractice enrollment Visa Status Missing Documentation License Status Occupational Health Screening/Medical Clearance

6. Credentialing Process Map

7. Provider Enrollment – The Mechanics Understand your pipeline Close coordination/integration with Medical Staff Office Be prepared Licensure Status DEA Status Training/Specialty CAQH

8. Provider Enrollment – The Mechanics Understand your audience The Practice The Billing Office The Provider The Plans Manage Expectations Under Promise and Over Deliver

9. Provider Enrollment – The Liaison

10. Provider Enrollment - Foreign Trained Physician Each plan is different Licensure Full License Temporary License Training & Board Certification Status

11. Questions