Sorin Davis, an expert with 35 years of experience in healthcare and marketing, speaks with us about his experience in leading the national launch of the Council for Affordable Quality Healthcare (CAQH)’s ProView credentialing system.
Sorin and his team’s work with CAQH is focused on developing collaborative initiatives to innovate the administrative process for efficient interactions between payors and their providers. Prior to the work conducted by CAQH the administrative process was full of challenges. To help alleviate these costs, CAQH’s core committee was given the rule-writing authority by the Affordable Healthcare Act (ACA) for the first set of electronic fund transfers (ETA) and electronic remittance advice (ERA).
Streamlining the Administrative Process
The administrative process had been slow and expensive due to redundant work, inaccuracies in billing, and inconsistencies in information gathered by individual States. The solution to this problem was to create a unified provider data collection system by leveraging the standardization of operating rules.
The CAQH Committee
To create these rules, CAQH organized the CAQH Core – a committee on operating rules for information exchanges. The CAQH Core committee worked with industry stakeholders to discuss administrative problems in order to create a system that fostered consistent, quality communication. In establishing a network of stronger communication, the CAQH were able to move forward with initiatives.
The CAQH Initiatives
The committee organized four main initiatives that aided the administrative process. These four main initiatives targeted specific challenges with an automated solution that minimized process redundancies and opportunities for errors.
- COB Smart Initiative (Coordination of Benefits)
One initiative made by the CAQH Core committee was COB Smart, which worked to coordinate the benefits for accurate payment from the first submission. This had been a major problem for providers and payors as inaccurate submission delayed payments. To make adjustments, providers had to file claim rejections and push for resubmissions while the payor had to reprocess claims and recover incorrect payments.
To solve this problem, the CAQH created a system that identified the primary payor – when there was more than one payor – and the person who must pay the primary. This ensured that claims were paid correctly the first time, greatly reducing delays.
- Enrollhub Initiative
Enrollhub was started to create a more efficient method for providers to enroll in EFT and ERA. The initiative found that providers had to connect with each individual organization that they would want to enroll with, creating a redundant process that took too much time.
The solution provided by Enrollhub had providers only enroll once, resulting in fewer transaction hassles. This also allowed providers to authorize organizations for electronic payments much easier.
- SanctionsTrack Initiative
An earlier initiative was SanctionsTrack, a national information repository for licensed disciplinary actions on all licensed providers. This repository was updated daily and connects electronically to all participating organizations. It provided a level of transparency on recent actions, as well as actions that were reversed.
- ProView Initiative
Arguably one of the most important initiatives by CAQH, it was previously known as the Universal Credentialing Data Source and used to address specific challenges concerning provider credentialing. The initiative placed emphasis on the starting phases of the credentialing process, because this was where the primary interactions between providers and payors were held.
ProView: Bringing It All Together
In 2002, The Universal Credentialing Data Source online tool was launched to consolidate the credential application processes into one digital form that satisfied all credential requirements. However, the online tool hadn’t been updated since 2002 and it struggled to integrate with modern technologies as required by the ACA. This lead to the creation of ProView to take its place for provider credentialing.
ProView uses a single Unified Provider Data (UPD) collection system, becoming the industry standard for collecting provider credentialing data. It is currently working with more than 1.3 million licensed providers at a growth rate of 7,000 practitioners a month, including MDs, DOs, PTs, PAs, NPs, and nurses for behavioral health. ProView introduced new functions that improved the usability and experience of the credentialing process.
New Features with ProView
ProView provides users with an updated interface that is user-friendly and maintains many of its older processes.
- The new ProView allowed documents to be transmitted electronically, whereas the Universal Credentialing Data Source tool used fax. While faxing solved many malpractice issues, it added time to the process and was vulnerable to disconnects.
- Currently, 13 states have unique applications that created a convoluted workflow. ProView has taken a holistic approach, addressing all requirements in a single form to cover all states.
- A self-registering system was created within ProView that allows providers to register in advance without waiting on an invitation by the payor. This is especially attractive for groups that hire and onboard new physicians often.
- ProView also offers a password reset function. Older systems required users to call and speak with an agent as an authentication process.
Initiatives conducted by the CAQH have made the administrative process faster, allowing fewer opportunities for errors and mistakes within the billing process. This ensured that all parties were compensated accurately and on-time, lowering costs on redundant work and loss of productivity.
To learn more about the amazing work by the Council for Affordable Quality Healthcare and the efficiency contributions made with ProView, check out our symplr education series webcast with Sorin Davis. For more information about user-friendly, efficient credentialing solutions, Schedule a Demo with symplr today!