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AzAHP Credentialing Alliance May 2012. Goal: To reduce the burden of credentialing currently placed on Arizona providers. P A R T I C I P A T I N G P L A N S. Care1st Health Plan Arizona CMDP Health Choice Arizona Maricopa Health Plan Mercy Care Plan Phoenix Health Plan

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Presentation Transcript

Goal:

To reduce the burden of credentialing currently placed on Arizona providers.


P A R T I C I P A T I N G P L A N S

  • Care1st Health Plan Arizona

  • CMDP

  • Health Choice Arizona

  • Maricopa Health Plan

  • Mercy Care Plan

  • Phoenix Health Plan

  • SCAN Health Plan Arizona

  • United Community and State (APIPA)

  • University of Arizona Health Plan

    ALL Arizona business lines (AHCCCS Acute/ALTCS, MA PD, D-SNP, Commercial).

    Together we represent over 1,115,000 members and over 15,000 unique providers.

    Plans DO NOT need to be a member of AzAHP to participate in the alliance.


S T R U C T U R E

HEALTH PLAN

HEALTH PLAN

HEALTH PLAN


O P T U M I N S I G H T

  • Nation’s largest CVO

  • Approximately 550,000 credentialing events/year

  • Alliance experience

  • Certified by NCQA, accredited by URAC, compliant with JCAHO standards


S H A R E D C O M P O N E N T S

  • Initial Credentialing

  • Site visits (PCPs & OBGYN)

  • Re-credentialing

  • Both practitioners (includes dental) and facilities/organizations

  • Utilizing CAQH for practitioner applications

  • Plans retain control over network decisions and their credentialing committee


I N I T I A L C R E D E N T I A L I N G

  • Practitioners joining existing groups

  • New practitioner/practitioner group


R E - C R E D E N T I A L I N G

  • Plan specific re-cred date

    • Dr. John Smith

      • PLAN A: 4/17/2014

      • PLAN B: 7/10/2013

      • PLAN C: 1/20/2014

        Alliance re-cred date: 7/10/2013


C U R R E N T A C T I V I T I E S

  • Contracts

    • OptumInsight

    • CAQH

    • Plan Participation Agreements

  • Workflow definition/Statement of Work

  • Network extracts from Plans to Optum due May 17

  • Provider communication campaign

  • Delegated oversight process & pre-delegation review

  • Expecting the implementation to begin in June and LIVE September 2012



AzAHP Credentialing Alliance

May 2012

Scott Cummings

[email protected]

602.778.1860


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