Geisinger Health Plan
Expediting the Credentialing Process
Geisinger Health Plan
Adrienne Bingaman, Provider Data Analyst
Geisinger Health Plan
October 10, 2013
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Geisinger Health Plan
The Challenge
Laws, regulations, and accreditation standards increasingly require
Health Care Organizations to carry out the same level of credentialing
that hospitals have long been required to carry out.
• Accrediting Organizations (NCQA, CMS, DOH)
• GHP Internal Credentialing Criteria
Health Care Organizations have found themselves changing the way in
which they do credentialing in order to respond to the demands of the
constant changes in the health care industry.
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Geisinger Health Plan
Meeting Expectations
Due to the ongoing changes of Health Reform, and in order to
foster business growth, in January 2013, GHP made the decision
to supplement our internal credentialing resources with the use
of a Credentialing Verification Organization(CVO).
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Geisinger Health Plan
The Process
GHP’s Credentialing Process:
• The Council for Affordable Quality Healthcare (CAQH) Universal
Provider Datasource is GHP’s standard credentialing application.
• Requests for Credentialing are facilitated by Provider Relations
Representatives.
• Standard turnaround time is 12-16 weeks.
• GHP’s Credentials Committee meets on a monthly basis (3rd Monday
of each month).
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Geisinger Health Plan
The Process
Provider Relations Representative will need:
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Full Name and Title (Degree) of applicant
Date of Birth
Provider NPI
CAQH Number
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Geisinger Health Plan
The Process
GHP’s internal process includes:
• Pre-Screening the provider’s application to ensure current attestation
and accessibility.
• Transmitting CAQH application the CVO via secure FTP site.
• Reviewing credentialing verifications from CVO upon return of
application.
• Reviewing provider profile for compliance with GHP credentialing
criteria, and accrediting body standards.
• Presenting provider profile to the Credentials Committee.
• Updating provider database and directory to reflect valid start dates.
• Notifying provider, in writing, of acceptance to GHP’s network.
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Geisinger Health Plan
Tips and Tricks
• Providers should update Attestation every 60 days.
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Offices should establish a regular review and update process
for Demographic, Specialty, and Insurance Information.
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Always ensure application is updated with copies of requested
documentation.
•
Responding to credentialing requests from GHP or other
credentialing organizations in a timely fashion is key to a quick
turnaround!
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