AzAHP Credentialing Alliance May 2012

AzAHP Credentialing Alliance May 2012

Goal: To reduce the burden of credentialing currently placed on Arizona providers.

PARTICIPATING PLANS Care1st Health Plan Arizona CMDP Health Choice Arizona Maricopa Health Plan Mercy Care Plan Phoenix Health Plan SCAN Health Plan Arizona United Community and State (APIPA) University of Arizona Health Plan ALL Arizona business lines (AHCCCS Acute/ALTCS, PD, D-SNP, Commercial). MA Together we represent over 1,115,000 members and over 15,000 unique providers. Plans DO NOT need to be a member of AzAHP to participate in the alliance.

STRUCTURE HEALTH PLAN HEALTH PLAN HEALTH PLAN

OPTUMINSIGHT Nation’s largest CVO Approximately 550,000 credentialing events/year Alliance experience Certified by NCQA, accredited by URAC, compliant with JCAHO standards

SHARED COMPONENTS Initial Credentialing Site visits (PCPs & OBGYN) Re-credentialing Both practitioners (includes dental) and facilities/organizations Utilizing CAQH for practitioner applications Plans retain control over network decisions and their credentialing committee

INITIAL CREDENTIALING Practitioners joining existing groups New practitioner/practitioner group

RE-CREDENTIALING Plan specific re-cred date Dr. John Smith PLAN A: 4/17/2014 PLAN B: 7/10/2013 PLAN C: 1/20/2014 Alliance re-cred date: 7/10/2013

CURRENT ACTIVITIES Contracts OptumInsight CAQH Plan Participation Agreements Workflow definition/Statement of Work Network extracts from Plans to Optum due May 17 Provider communication campaign Delegated oversight process & pre-delegation review Expecting the implementation to begin in June and LIVE September 2012

Questions

AzAHP Credentialing Alliance May 2012 Scott Cummings [email protected] 602.778.1860