Credentialing Data General Information FAQs
The following is a list of questions or coments shared with OneHealthPort about the Credentialing Data Management project, this information is updated whenever new questions are submitted.
Start Dates, Orientation, Information, Communication:
Upload/interface with credentialing software vendors:
Master Data Collection and Updates:
In 2009 State Senate Bill 5346 was passed which includes a requirement that the Insurance Commissioner oversee the appointment of a private sector
lead organization to manage the selection and implementation of a statewide provider database to collect and share information for credentialing, privileging and other uses.
The lead organization named was OneHealthPort. The vendor selected was Medversant and their application that collects provider data and allows the practice organization to manage
all provider data is ProviderSource. The global service operated by OneHealthPort to manage sharing the data collected is called Provider Data Service.
Your practice can enter data and manage practitioner records in the ProviderSource application you will reach from a link on OneHealthPort. The application is free for provider organizations and uses your OneHealthPort login. Organizations who need your data will contract with OneHealthPort
Provider Data Service to get data for credentialing and privileging.
New Questions - posted December 2, 2010
Start Dates, Orientation, Information, Communication:
When will providers be expected to log on and have their information completed?
Providers can enter data anytime they wish now that the Service is open. They will receive regular notices from hospitals and health plans when they are looking for information for the next re-credential or privileging event. Nothing about notifications from hospitals and health plans has changed, the data will be picked up from the ProviderSource application once completed and attested and needed by an organization for their workflow.
When will organizations be expected to log on and obtain information from OHP?
Organizations are expected to notify providers in advance of their need for completed records and login to Client Portal application to request and download completed records. The organization must be contracted with OneHealthPort to access Client Portal.
We understand that participation is voluntary at this time, but can become mandated by the OIC if there is not sufficient compliance December 31, 2010.
The concept in SSB 5346 is that voluntary adoption rather than regulation is the best approach to make change universal. That is not the same thing as a purely voluntary model where each organization can decide whether to adopt or not. The intent of the Legislature is clearly that all hospitals, health plans and providers adopt the requirements of SSB 5346. If this universal adoption does not occur voluntarily, the bill authorizes the OIC to take a regulatory approach.
If systems are not ready for both provider to go online and administrators to manage providers, what provisions are in place for extension beyond January 1, 2011?
Systems have been operational since November 3, 2010 for providers and OHP Administrators to enter and manage provider data.
The communication plan, at this late date, remains unclear. We were informed that OHP will send email blasts at appropriate times with suggestions for how to reach providers.
OHP has emailed all OHP users and posted messages on the website multiple times over the last few months. OHP shared a message with all contracted hospitals, health plans, WSMA and WSHA who have also been spreading the word to the provider community. WAMSS has also been provided the information to share with their members and OHP has attended three WAMSS events around the state in person to make sure the association is getting information and has plenty of opportunity to ask questions. OHP has attended MGMA, WSMA, Pharmacist and Physician Executive conferences where demonstrations and information was shared.
Exactly what information is being distributed to the providers about this?
OHP's message focuses on explaining when the application is available and the basics of getting started. There is a full web page (Click here to go to web page) that contains videos and instruction sheets for getting started. This information has been updated each month to reflect where the project was and what to do while we were waiting for the new application to be ready. Health Plans and the WSMA and WSHA have also published updates to their members and OHP has met with groups at the request of both associations. OHP added a feedback link on the ProviderSource information page after Go-Live so users could offer feedback direct to OneHealthPort and Medversant.
How are providers being informed of their responsibilities?
OHP has used its own messaging and the messaging of the hospitals, Health Plans and associations to spread the word. Individual organizations that Credential and Privilege providers are responsible for notifying the providers when they need their information, by when and reminding providers that data collection is through the FREE ProviderSource application on OneHealthPort.
What, if any training has been developed for providers to enter their data?
Brief training videos are available on the OHP ProviderSource information web page. There are also printable documents and a WPA for those who need to gather information before they get started inputting data. There are online help and field-level information buttons in the ProviderSource application to assist in answering questions as data is being entered. The Feedback survey asks for additional ideas on what would be helpful to assist users doing data entry and document attestation.
We understand that the only equipment requirement for providers is a computer with a web browser to access and complete the application. Do they need any other equipment?
The requirements are a computer with a web browser, an Internet connection and a OneHealthPort UserID.
How are hospitals and health plans being systematically trained on their responsibilities and use of the software?
Hospitals and Health Plans will receive documentation and a video tour of the Client Portal when that application is completed and ready for use. OHP has offered several demonstrations of the prototype and is awaiting the final application during December 2010.
Will there be a technical support online for providers and administrators/account managers?
OneHealthPort offers first tier technical support via the 24x7x365 call center for providers and administrators. If there are application questions, ProviderSource has been responding appropriately.
Which providers does the law apply to (dentists, psychologists, social workers, advanced practice nurses)? We would like an inclusive list.
The law defines "health care providers" as it is defined under RCW 48.43.005 and it also expressly includes facilities as defined in RCW 70.41.
Will companies that are currently using CAQH be required to use Medversant?
Yes, CAQH was an unsuccessful bidder for this service during the RFP process. OHP offered to exchange data with CAQH for its customers in Washington State. However, CAQH decided not to do so. Therefore, all data collection in Washington State for credentialing and privileging purposes will be through this Provider Data Service.
Will all out of state insurance companies such as Sterling, who don't use CAQH be required to use Medversant?
Yes, all commercial and public payers requesting information from Washington State practitioners must make their requests through the Provider Data Service.
Do hospitals fall under the jurisdiction of this bill?
Yes, any healthcare entity collecting data for the purposes of credentialing or privileging a provider falls under this law.
Does the OIC regulate hospitals as well as insurance plans?
It is not OHP's role to determine regulatory responsibilities. The Legislature assigned responsibility to the Office of the Insurance Commissioner for enforcement and oversight of SSB 5346. OHP's reporting responsibility is to OIC and the Legislature. The OIC has indicated to us it believes it has the authority to regulate hospital adoption of the provisions of SSB 5346. The Legislature has also made it clear to us that it expects universal adoption either through voluntary adoption or if that fails regulation.
Upload/interface with credentialing software vendors:
Many members have asked about uploading their existing provider data from their credentialing software programs. We were
informed that the "upload" function is not finished.
OHP is working with Medversant to publish a process for loading standard files from other systems to save large organizations time in loading data. The standard file format has been available for several months, the process to request access to load data and a secure file transfer process is being finalized and tested now and should be available in December 2010 for interested organizations. OHP will publish a request form on the OHP website for interested organizations to sign up for file loading with Medversant.
Will OHP populate hospital/plan credentialing software programs?
There are multiple options available to hospitals and health plans for how they can receive the data they purchase. Data can be downloaded as files or requested as a web service. Custom data triggers can also be purchased based on events like license changes or key data changes.
Are WSMA and OHP aware of the costs and difficulties associated with the "patches" required for the various credentialing software programs?
The Legislature wrote the law and presumably considered a blend of cost and benefit issues when they authored the bill. OIC and OHP recognize that all change, even positive change carries costs. However, maintaining the status quo also imposes costs. We appreciate the costs and challenges incurred by all parties, those dealing with the current system and those attempting to make improvements.
We understand Washington State law accepts digital signature and certainly includes L&I and DSHS. We were informed that acceptance by Medicare is "unknown." If not acceptable by Medicare, then what provisions are in place? A proposed solution is to print the view of the screen with the electronic signature. Has this been assured as an acceptable substitute for "wet" signature by Medicare?
The States cannot legislate a Federal program to participate in a state process. Medicare is not required to participate. In the event Medicare opts to participate, the then current federal standards would be reviewed.
Conflicting data between what a provider enters and what has already been primary source verified by organizations exists. When conflicting information is uploaded, the provider is encouraged to correct the online data. What information is most accurate, current and should be trusted?
The latest attested data is the most current record and should be trusted. Only the provider can attest to their data so there should not be more than one version of the most recently attested data once providers enter their data in the ProviderSource application. The ProviderSource application checks primary sources before the record is released for use and promts the provider to correct any differences in their record.
Providers are required to attest to their data as needed and when their information has changed.
Providers are asked to attest to their data at least once every 150 days or when fields that require an attestation are changed. Not all fields require an attestation so minor changes to records will not trigger a new attestation.
Will the provider be notified (and how) when they need to attest/update their data on OHP?
The Provider Source application will notify the provider or the person they have designated for notices. If they or an administrator are in their account, the application will notify them if a record change now requires an attestation update.
In theory, the system administrator (organizations can have more than one administrator) issues passwords, records them, and the provider must logon to finalize and attest to the application. However, the system administrator can send out passwords and then log back in and attest as the provider. We understand that there are no systems in place to ensure that the provider is attesting to the information, thus an assistant or staff person can enter the information, create a password for the provider and attest to the information all without the provider's involvement. This is a compliance issue.
All systems are vulnerable to some degree. It is not possible to ensure perfect security in the OHP system or any other system. However, the OHP system is designed to minimize risks. The OHP system does not allow the Administrator to see the password of the subscribers they nominate. The administrator nominates the user and shares a one-time use activation code with the provider who uses that code to complete their account setup, set a password and select and answer secret questions. The user also accepts a user agreement that says they are the person the identity is being requested for. If they falsely attest and create the providers identity for them, they have committed fraud. The system logs the user ID of the person doing the attestation; if that person has lied or has shared their password then they are committing fraud and can have their identity revoked. The system cannot detect when a user is lying but that does not mean the system is out of compliance, the user is and once discovered the user is liable for any damages. The organization also has responsibilities for its administrators so if there is a breach of identity then the user and the organization can be held liable. Most organizations realize this and have policies that guide their staff and administrators to minimize risks for the organization.
Master Data Collection and Updates:
How and who will monitor the data collection elements for updates for any state or other regulatory compliance changes? As of Sept 24, 2010 OHP does not have an agreement with DSHS (DSHS has new attestation questions).
Within the PDS, OHP is responsible for maintaining the Washington Practitioner Application as the primary document for data collection in Washington State. OHP works with WAMSS to ensure OHP is aware of changes to the WPA for updates to the ProviderSource data collection process.
Medicare requires that a foreign born provider provide proof of US citizenship. Will OHP require that foreign born providers provide these additional documents for Medicare?
OHP is not responsible for Medicare requirements but for the collection of the WPA application.
Will the ProviderOne checklist for DSHS be included on the application?
There is no provision in the law for non-standard data collection and no mention of this checklist in the Washington Practitioner Application. Besides the WPA, data is collected for NCQA, Joint Commission and URAC requirements based on custom contracts.
Who will update the provider's licenses upon expiration? Is the state working on an interface with their information to upload into OHP? Could new applicants for State licensure's information upload directly into OHP?
For now the provider is responsible for making sure their information is accurate, complete and updated. The ProviderSource application checks the Washington State Dept of Health licensing status and will notify the practitioner during the application audit if it finds different information than what the provider has supplied. In 2011 OHP will work with the Dept of Health on interfaces with the Medversant application. At this time we do not know the extent of the interface that may be developed.
Can a provider organization expect that providers will get reminders of license, DEA, Board cert, etc, expirations?
Providers will receive notice reminders for information such as license and insurance renewals where a field collects the data about the next renewal. Organizations released to receive the data will have the option to pick the data up for themselves when they are checking records or pay additional fees for custom triggers to be notified of record updates.
Once a provider has started completing information on line, can an organization check to see progress and if it is completed? Is there an alert for completed provider information?
Administrators can see how much is completed for a provider record in their organization. Organizations waiting for the record to be ready for pickup can see basic status but cannot view or download the record content until it is complete and fully attested
Is the data available instantly after it has been entered? If not, how long after it is entered?
The record is ready moments after it is attested.
Does each provider select which organizations he or she releases their OHP online data to?
One of the final pages before attestation allows the provider or their administrator to select all the health plans they wish to release their records to. Hospitals listed in the affiliation section are also included on the release list and can be selected or unselected for record sharing. There is also a selection to allow OneHealthPort access to non-confidential data for use by the Washington State health Information exchange.
When asked if any organization can access/pay for any provider's data in Washington, we were informed that any organization can access limited non-confidential information on any provider as long as the organization is affiliated with OHP for the tier fee. Confidential level of information can only be purchased when affiliated with OHP.
The Data Policy indicates the confidential portions of the record can only be shared with organizations specifically doing credentialing or privileging for that specific provider as assigned by that provider. OneHealthPort has identified use of the non-confidential data to populate the Statewide HIE Provider Directory and asks permission for this use in the data release section of the application. Other uses of the non-confidential data are allowed but have not been identified to date.
We support a project to have one on-line application for health plans, hospitals, and state licensing; however, we strongly feel that privileging should not be a component of this. Privileges are provider specific relative to education, training and experience and facility specific as required by The Joint Commission and staff resources.
We respect your position. However, that question is no longer on the table for debate. The Legislature acted and included privileging in the bill. We are obligated to make our best effort to implement the law as written. SSB 5346 requires data collection for credentialing and privileging is through a common process. The data collection can be more standardized while maintaining individual process and committee work for each organization. The law does not change the privileging process nor does it impact the privileging decisions made by individual facilities or organizations.
Reappointments should be a secondary project once the initial process is working well. We could agree upon a state wide reappointment application, similar to the WPA.
If WAMSS wishes to create a separate data collection for reappointments similar to the WPA, OneHealthPort will work to verify this meets the community need and gets incorporated in the data collection process.
Comment: "I had great hopes that the OHP would be a good solution for locum tenens processing; however, they confirmed that Tier 2 only would provide one hospital reference. They did not provide any pricing for additional hospital queries, so this really does not help us."
The ProviderSource is a good solution for data collection for Locum tenens since data is available when you need it. Additional reference verification is available at a custom price and can be requested by any organization.
Several members expressed concern about the security of their jobs, particularly in physician groups. Another concern about Washington jobs is that credentialing work for the State subsidized programs is being sent overseas. Assurances should be made to keep these jobs in Washington or at least the USA.
While we understand the concern about jobs and outsourcing overseas we have no role in determining the personnel decisions of any individual organizations. However, it is important to understand that the Medversant contract requires that all jobs are performed in the Unites States.
If we have contracts with out of state health plans, can they become subscribers to the Provder Data Service, or is the service only for Washington State Health plans and hospitals?
Any hospital, health plan, payer or third party organization doing credentialing or privileging can subscribe to the Provider Data Service to purchase a copy of your data collected by the ProviderSource application. There is no geographical limitation. Confidential information can only be
purchased for credentialing and privileging uses. Click on the link to find out more about pricing and contracting for the Provider Data Services.
We are already registered with CAQH, is this separate from CAQH? Will I have to enter data in both systems?
This will replace CAQH as the standard provider data management source for all health plans and hospitals in Washington State. Once you have entered data in the Medversant system, you can stop entering it in the CAQH system.
Is Medversant coordinating with CAQH so that a data dump can populate my current data?
No, there won't be a data transfer from CAQH to Medversant because there are differences in the data. Some of your data will be pre-populated based on the Medversant technology that crawls the Internet to find your data. This will require that your practice enter any missing data and all pre-populated data must be
reviewed and verified to confirm it is the most current information.
What's in it for our practice?
Your practice will have a new way to store and manage all your provider data and reduce the hassles of paperwork and forms from 12 different payers and 4-5 different hospitals or whatever the numbers work out for your practice.
The provider community helped craft the language in SSB 5346 based on the frustration with the current repetitive paper process for credentialing and privileging.
Does this mean there will be just one credentialing and privileging process for all hospitals and payers in the state?
NO, this does not change the process each individual payer, hospital or other credentialing and privileging organization must oversee. This new service simplifies the collection of the data and documents. This also gives us an opportunity to look for ways to
further improve the process and other uses of the data.
What does ProviderSource do and not do when it comes to Credentialing?
The ProviderSource application collects data and required additional documents (copy of your license, copy of your driver's license, etc.) for use by staff doing the credentialing process for payers, hospitals and other organizations. It simplifies management of your data and documents.
The service does NOT replace the process and committee approvals at each individual organization that does credentialing. It does not change the communications those organizations will need to have with you around credentialing.
How will this work with privileging requests at one or more hospitals?
The practitioner record will be used to collect all the common data. OneHealthPort is working with hospitals to help simplify the very complex process of data collection for privileging. Because that
process can be very different at each hospital or health system, the initial process will focus on simplifying access to the required forms for each hospital. You will need to fill out the individual forms and load them into the document library. Once loaded you will also need to "affiliate" them with a specific facility so they can access those documents. There will be
more detailed information about privileging documents during July as we fine tune that less standardized data collection process.
Who can use this new service?
Any licensed healthcare practitioner who is credentialed or privileged by a health plan, payer, hospital, TPA or care organization will now input all data and documents into the ProviderSource application.
How will I know when I should enter my data and what is needed by different organizations?
The organization scheduling the re-credentialing or privileging work will notify the practitioner of the process and any additional documents they will need completed and loaded into the ProviderSource document library.
Is there a fee to use this new service?
The ProviderSource application is a free service that allows practitioners and their organizations to manage the data and documents needed for Credentialing and Privileging. There is no charge for practitioner use for data management.
Organizations wishing to use the data for credentialing and privileging will contract and pay through the Provider Data Service managed by OneHealthPort.
Will there be training on how to use this new application?
There will be online training videos you can watch at any time, FAQs in the application, help menus and mouse-over explanations in the application and webcasts to provide an overview.
When do I begin putting in my information?
Once the ProviderSource application is live, you can start entering data at any time. We will announce when the service is open for data entry. Or you can wait for a request from a payer or hospital based on an upcoming credentialing or privileging requirement.
Will I need a new login and password? Is there a registration process before I start using the application?
The ProviderSource application is linked to the OneHealthPort security service and will accept your current OneHealthPort user ID and password. There is no additional registration or setup required.
What if I don't have a OneHealthPort login, how do I get one? What does it cost?
The OneHealthPort login is free. If someone in your practice is already using OneHealthPort then you need to find your OneHealthPort administrator and they can nominate you for a login. If your office has not registered with OneHealthPort, click here to register for a OneHealthPort login
How secure and confidential is my data in this new application?
The application is very secure using all the latest in security. Access to the individual records for inputting and editing data is based on users in your OneHealthPort organization. A OneHealthPort administrator for your organization determines who can see and
edit records on your practitioners. Individual practitioner records are tied to a OneHealthPort login since the practitioner will need to verify the final record and attest to it with a digital signature in the application. Any organization wishing to purchase
the data must verify their identity and use with OneHealthPort.
Is there something that outlines who can use my data and for what purposes?
The OneHealthPort Provider Data Service Policy outlines the principles for sharing data.
Will I be able to print a copy for my records or mail to someone who needs it?
Yes, the practitioner or their data entry designee will be able to print the document. The data will be stored and can be re-visited at any time for edits and updates. In this first year of transition to the new services, hospitals and health plans may request
a paper copy of the document until they are able to connect and pick up the electronic data direct from the Provider Data Service. In 2011, all requests from payers, hospitals and others should be for electronic data in the ProviderSource application.
Does the practitioner have to enter their own data or can someone do that for them?
The practitioner can designate one or more persons to manage their data entry and document management. The practitioner can not delegate the final attestation to the record, that must be done by the individual practitioner.
Will the designee be able to load files from a file if they have a lot of practitioner records in their organization?
Yes, there will be a standard record format and the ability to upload a file. This file upload will not cover the complete record so additional data entry may be needed to complete the practitioner file.
How often does the practitioner have to attest to their record?
OneHealthPort has proposed attestations be required every 150 days to meet national credentialing requirements. Some organizations would like the attestation to be every 90 days so data and records are current and available whenever needed. The initial requirement will be 150 days with reminders to the "alerted" contact when it is time to re-attest.
Staff can do all the prep work to update the records at any time but the practitioner will be required to do all attestations for them self.
How will I know if a health plan or hospital has picked up my completed records?
Our practice is in Spokane and serves patients from Washington and Idaho, do I have to do a different process for Idaho or national payers?
The ProviderSource application can capture all the data you need to meet needs of any organization. If the organization does not pick data up electronically, you can print and sign a document to share with them. SSB 5346 requires all payers, hospitals and other credentialing and privileging organizations regardless of their state or national status to
participate by 2011 so that paper documents can be minimized. SSB 5346 applies to your practice in the State of Washington. If you have practice locations in another state, you need to comply with any requirements set by that state. The ProviderSource application will ask which states the practitioner is licensed in and add questions to cover requirements in individual states.
Do I have to send additional documents to the health plans or hospitals after I complete my credentialing application?
The ProviderSource application has a document management library. You will be directed to upload documents and store them in the system. This allows you to save them in a secure space and update them if needed over time.
This also allows the organizations who need them to have access to them without bothering you to send and resend them.
Is there a way that I give permission to access my data and documents?
In the ProviderSource application you will have a chance to set up the health plans you wish to share data with and the hospitals and facilities you affiliate with. You will be able to update this information at any time. Only organizations you have permitted will have access to your confidential data.
Can I distinguish my primary practice site if I practice at multiple locations?
Yes, in the ProviderSource application you will be able to setup information about multiple practice locations and select which one is your primary practice location.
Do I need an NPI number? What if I don't have one?
Yes, each practitioner will need an individual NPI number since the system indexes records on this unique number. If you don't have a NPI number, you can
complete the application online at https://nppes.cms.hhs.gov
Is this required for all providers, some of my providers are not licensed?
The ProviderSource application should be used by any licensed healthcare practitioner who is required to be credentialed or privileged by payers, hospitals or other healthcare entities.
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