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AzAHP Credentialing Alliance May 2012

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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
slide2

Goal:

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

slide3

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.

slide4

S T R U C T U R E

HEALTH PLAN

HEALTH PLAN

HEALTH PLAN

slide5

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
slide6

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
slide7

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
slide8

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

slide9

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
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AzAHP Credentialing Alliance

May 2012

Scott Cummings

scummings@care1st.com

602.778.1860