La Pine: Vermonter shares experience with CAQH application

Terry Burbo, CPCS, Credentialing Supervisor at Vermont Managed Care, in Burlington, VT and President of Vermont Association Medical Staff Services spoke with me regarding their experience with the State’s mandate to use the CAQH application.  Terry stated that approximately 5 years previously, a group had organized to develop a state-wide application.  All that work was lost when the mandate for CAQH use was approved.

I asked Terry to share some of the barriers to implementation of the use of the CAQH application.  First, it took a long time to implement partly because many hospitals were not aware of this recommendation and felt caught off guard.  At first there were many complaints from providers regarding the length of time required to complete the on-line application (estimate 1 ½ to 2 hours).

Another consideration was the cost to the hospitals, especially smaller facilities.  CAQH now allows hospitals to form an “association” whereby the initial administration fee of $5,000 ($3,000 year each following year) can be divided among the member facilities.

In order to help providers with the application process, Terry and her group took the time to actually sit down with a provider and go through the process.  They also developed a cheat sheet that informed the provider of the necessary documents that would be needed to complete the application.

Did the implementation of the CAQH application have an impact on the application processing time?  Terry commented that at first it did slow the process somewhat but today they are able to average a turn-around of approximately 30 days.

Each Vermont hospital also requires additional documents in addition to the CAQH application, such as facility-specific authorization forms, group practice information, and of course, forms to request privileges.

Perhaps we can learn from Vermont’s experience as other hospitals consider implementation of the CAQH application.

Carole  La Pine, MSA, CPMSM, CPCS