To simplify the way Washington, D.C.-area physicians are credentialed, CAQH, the Council for Affordable Quality Healthcare, today announced the launch of its Universal Credentialing DataSource service. CAQH, a not-for-profit alliance of America’s leading health plans and networks, developed this service to help physicians more easily and cost-effectively provide required credentialing information to healthcare organizations.

For physicians, the process of regularly submitting licensing, educational and practice information to health plans, hospitals and other healthcare organizations is an essential, but often redundant and time-consuming administrative task. All physicians contracting with a health plan or hospital are required to periodically submit this information. It is not uncommon for a physician to contract with 10 or more healthcare organizations, each of which has a separate credentialing process.

The CAQH Universal Credentialing DataSource service allows physicians to submit their credentials only once into a uniform system, and provide periodic updates, to satisfy the credentialing needs of all participating healthcare organizations. There is no cost to physicians to use Universal Credentialing DataSource, and information can be submitted anytime, either on the Web or by fax. On a quarterly basis, physicians are prompted via e-mail to confirm that the data on file remains current. Data is maintained by CAQH in a secure, state-of-the-art datacenter, and is only made available to healthcare organizations that have been authorized by each physician. Healthcare organizations are automatically notified when a physician’s information changes.

"CareFirst is pleased to be among the participants and supporters of the efforts to simplify administrative processes in the health insurance industry. This new credentialing effort will pay off immediately for our provider partners," said William L. Jews, president and CEO of CareFirst BlueCross BlueShield. "By streamlining what has long been a tedious and repetitive process, Universal Credentialing DataSource provides much-needed administrative relief to physicians and their office staffs."

Under the fragmented system that now exists, physicians typically need to go through the credentialing or re-credentialing process with individual health plans once every three years, and information does not always remain current. With Universal Credentialing DataSource, physicians or their office staffs are asked to spend just a few minutes each quarter to confirm that their information is complete and accurate. This simple process helps ensure that data remains current for credentialing and other important purposes. For instance, healthcare organizations can use the data to ensure that physician information is always up-to-date in their electronic and paper directories.

In addition to CAQH members, any healthcare organization with credentialing requirements can, and is encouraged to participate in Universal Credentialing DataSource. Participating healthcare organizations pay an annual per physician/provider fee for unlimited access to completed records, in addition to a small annual administrative fee to offset system maintenance and customer service requirements.

Officials from several health plans serving the District of Columbia have been involved in developing the CAQH credentialing service. CAQH also obtained the input of physicians, their professional associations, and national accrediting organizations.

Universal Credentialing DataSource first launched in Virginia and Colorado in March 2002. It will be deployed in six additional states by the end of 2002, and launched nationwide in 2003.

About CAQH

The Council for Affordable Quality Healthcare (CAQH) is a not-for-profit alliance of America's leading health plans and networks, committed to improving the quality of healthcare and reducing administrative burdens for physicians, patients and payers. Created in 1999, CAQH member organizations today provide and administer healthcare coverage for more than 100 million Americans.

CAQH members include: Aetna, American Association of Health Plans, Anthem Blue Cross and Blue Shield, AultCare, Beech Street Corporation, Blue Cross Blue Shield Association, BlueCross and BlueShield of North Carolina, CareFirst BlueCross BlueShield, CIGNA HealthCare, Empire BlueCross Blue Shield, FirstHealth, Great-West, Group Health Cooperative of Puget Sound, Health Insurance Association of America, Health Net, Inc., HealthPartners, Highmark Blue Cross and Blue Shield, Horizon Blue Cross Blue Shield of New Jersey, Independence Blue Cross, MultiPlan, Inc., Mutual of Omaha, Oxford Health Plans, PacifiCare Health Systems Inc., Private Healthcare Systems, Inc., The Regence Group, and WellPoint.

Rachel Rosten
(212) 445-8269

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