Technology to Streamline Physician Credentialing

CAQH ProView, a standardized electronic application form formerly known as the Universal Provider Datasource, can reduce the time and resources needed for credentialing. It can also minimize the opportunity for manual error, reduce duplicative paperwork, and reduce administrative costs.

The free database enables providers to enter a range of demographic and professional information into a secure datacenter, creating a profile that can be shared electronically. The provider can then submit it to multiple authorized healthcare organizations in every state.

"That makes the process a little easier and it also shortens the time as you won't need to fill out as much paperwork," says Gerry Malloy, a partner with medical practice consulting firm Global Health Management Services. The form was developed with health plans, health systems, and providers.

Patrick Boyle, vice president and director of managed care for Catalyst Consulting, says new recruits should be directed to submit their information and upload supporting documentation to the CAQH database immediately upon hire so they can obtain a profile number. The office manager, or person in charge of credentialing, can then take that number and submit to each individual health plan.

"That's the trick," says Boyle. "Each plan has their own process, but the majority of the major plans use CAQH so it makes it more streamlined."