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From the CRC blog: Is there a universal credentialing application in the USA?

Credentialing & Verification Update, June 18, 2008

Editor’s note: The following is an excerpt of an entry that appeared June 2 on The Credentialing Resource Center’s new web log ("blog"), which is a place to learn and discuss issues critical to today’s medical staff professionals. To access the blog, go to www.online-crc.com. Contributor Carole La Pine, CPMSM, CPCS, the credentialing department director for Saint Joseph Mercy Health System in Ann Arbor, MI, posted the entry:

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, Sorin Davis, executive director of the CAQH, presented an update to a group of Michigan Association Medical Staff Service members. To get all participants at the same knowledge level, Davis gave a brief overview of the development of  CAQH which began in 1999 as a nonprofit business entity. 

The philosophy of development of the UCD is credentialing is a three-step process:

1. application
2. primary source verification (PSV)
3. review and decision

UCD is the answer to providers' problems, which were identified as: redundancy—how many applications are one 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 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 online 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.

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