Physicians in the Dallas-Fort Worth area will now need only to fill out one form--instead of the traditional dozens--when applying for credentials with a group of insurers.
The Dallas-Fort Worth Business Group on Health created a common credentialing form for insurers--and eventually hospitals--to use. Seven large insurers, which represent the majority of health insurance business in the Metroplex, have agreed to use the form in lieu of their own credentialing applications. The form was unveiled in April.
"I wish I could say we solved all the problems of the world," says Fred Ciarochi, M.D., president of the Dallas County Medical Society. "It's a great start . . . Whenever you apply for (credentials), you go through an eternal process. There are so many companies out there. Why not get common information and put it in a format?"
The form will be accepted by AetnaUSHealthcare, Blue Cross Blue Shield of Texas, Cigna Healthcare, Humana, PacifiCare, Texas Health Choice and UnitedHealthcare after June 1. Several plans will use the form in all Texas markets.
The business group is a 140-member coalition of employers working toward market-based healthcare reform. Members include American Airlines, Exxon, GTE and Southwest Airlines.
It began a series of roundtable discussions to focus on how to get health plans and physicians to work together.
"We were concerned about animosity between physicians and managed care organizations," says executive director Marianne Fazen. "It was affecting (area) employees."
Credentialing, which physicians say swallows hours of time, was identified as an area where insurers and doctors could work together.
Typically each health plan uses its own physician credentialing application. Most of the requested information such as education and professional training is the same on every application. However, the wording or placement may vary.
"Some (physicians) have hired full-time staff just to do credentialing," Fazen says. "If you have a doctor who has 20 affiliations with health plans and hospitals . . . they'll be filling out the same information 20 different times. It's just a hassle-laden process that was in place. We tried to streamline that and get rid of the hassle factor."
The forms will be available online, and physicians will be able to file their applications electronically (see related story, page 74). Local medical societies also will distribute the free form to their physicians.
The coalition's task force--which was comprised of credentialing experts from health plans, hospitals and physicians--developed a standardized application that would meet most of the information needs of health plans and requirements of accreditation organizations. Fazen says the common form meets standards of the Joint Commission on Accreditation of Healthcare Organizations and National Committee for Quality Assurance.
The group used an application from the Medical Society Credentials Verification Organizations of America as a blueprint and then built the common form. There are certain questions each insurer and hospital asks of physicians when deciding whether to offer credentials.
The application is structured so physicians need to complete a core set of questions once. It also allows plans and hospitals to add a second part for additional information, such as ethnicity and recent medical education.
The HMOs, PPOs and hospital systems took the form to their legal departments for approval. The Texas Medical Association and the Texas Association of Health Plans are urging statewide use of the form.
Ciarochi says he spends 15 to 20 minutes on the basic questions for each credentialing application he completes. That doesn't include attaching copies of continuing education forms or answering additional questions.
Only health plans have agreed to use the common form. Hospital executives are reportedly still discussing how and when to adopt the form.
"The standard physician credentialing form brings consistency across credentialing entities, such as health plans and hospitals," United Senior Medical Director Robert Jacqmin, M.D., says in a statement. "More importantly, it reduces the workload for our provider and physician partners."