Credentialing

Credentialing Overview

HCAS implemented a centralized and streamlined provider credentialing process as its first initiative. This process offers a single point-of-entry for providers to submit credentialing information that HCAS participating health plans use to verify a provider’s qualifications prior to network participation. Each health plan makes independent decisions regarding a provider’s eligibility for participation in its network.

HCAS is committed to achieving significant efficiencies in the credentialing process by building on the success of a statewide physician credentialing initiative in Massachusetts. HCAS extended its centralized credentialing process to include physicians and allied health providers working in several New England states.


Process Components

HCAS participating health plans partner with CAQH® to collect and store a provider’s credentialing information. Information is collected one time from providers, reducing the need to submit multiple applications to different sources.

A provider’s credentialing data is then utilized to complete the primary source verification process. Aperture Credentialing, LLC a national credentials verification organization (CVO), performs the primary source verification function on behalf of HCAS participating health plans.

Benefits

Health plans are required by law and by accrediting organizations to credential providers on a periodic basis. Due to these requirements, there are significant efficiencies to be gained by centralizing the process. The most significant of which is that it enables providers to complete the application process one time for several health plans. In addition, when a provider completes the recredentialing process every few years existing data can be updated, reducing the amount of time that providers spend on administrative work.

 

Accreditations

The HealthCare Administrative Solutions credentialing process utilizes Aperture Credentialing, LLC to perform primary source verification on behalf of its participating health plans. Aperture Credentialing, Inc., meets NCQA standards for managed care organizations.

"Achieving certification from NCQA demonstrates that Aperture Credentialing, LLC has the systems, process and personnel in place to thoroughly and accurately verify providers’ credentials,” said NCQA President Margaret E. O’Kane. “These resources help health plan clients meet their accreditation goals.”

Aperture Credentialing, LLC is NCQA-certified for the following verification services:

Application Processing
Education and Training
DEA Certification
License to Practice
CVO Application and Attestation Content
Malpractice Claims History
Medicare/Medicaid Sanctions
Ongoing Monitoring of Sanctions
Medical Board Sanctions
Work History

The National Committee for Quality Assurance is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral health care organizations, preferred provider organizations, new health plans, physician organizations, credential verification organizations and other health-related organizations.

 

 
 

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