La Pine: Is There a Universal Credentialing Application in the USA?

Some may say that the Council for Affordable Quality Healthcare's (CAQH) Universal Credentialing Data Source (UCD) is such a tool. 

On May 28, 2008, Mr. Sorin Davis, Executive Director, CAQH, presented an update to a group of Michigan Association Medical Staff Service members.  To get all participants at the same knowledge level, Mr. Davis gave a brief overview of the development of  CAQH which began in 1999 as a non-profit business entity.  The philosophy of development of the UCD is credentialing is a 3-step process:  1) application, 2) primary source verification (PSV), and 3) review and decision.  UCD is the answer to providers' problems which were identified as:  redundancy – how many applications are 1 too many?, the lengthy process, and no consistent recredentialing cycle.  For those who may be thinking that the “process” time is not all that long, let me explain the issues involved.  The necessary follow-up required to complete an application may be based on omissions, or data elements not completed, problems with legibility, use of unfamiliar abbreviations, and incomplete work history dates.

All these require contact with the provide to clarify or complete the application before PSV can be completed.  How much time does this take?  It depends on the success in contacting the provider.  The time could be short with a mere telephone call or significantly long if the provider is relocating.  On average, the processing of an application is about 60 days.  According to statistics provided by Mr. Davis time and expense is broken down into 40% data collection (completing an application), 25% PSV, and 35% review and decision.

CAQH's goal is to use technology to ease the credentialing by creating a single on-line data source tool to import data into a central database, allowing providers to own their data.  CAQH requires that updates to the information be at least every 120 days.  As of May 22, 2008, 590,000 providers are registered with 505,000 complete applications (along with required documents) already in the database.  Four hundred healthplan organizations are currently using the CAQH application.  All Vermont hospitals and George Washington University are current users.

News Items:

CAQH is looking into the possibilities of allowing facilities to upload provider information into the CAQH database.  The issue will be how to maintain current information and how to resolve the issue of providers attesting to the accuracy of the data.

Hospitals are now considering participation and several state Medicaid programs are in the discussion stage of requiring providers to enroll in UCD.  An interesting incentive for hospital participation is the “association model” where several hospitals could form an arrangement to pool their responsibilities for the administrative charge ($5,000 for the first year, and $3,000 for every following year).  This cost would be divided among the participating hospitals at a considerable savings to all.

CAQH will be conducting a number of quality evaluations to determine the accuracy of the data in the database.

Considering that the UCD is up and running, that providers are voluntarily participating, several payors are requiring participation, will the CAQH UCD become the universal application?

What's your opinion?

Carole La Pine, MSA, CPMSM, CPCS