Universal Credentialing Form Gaining State Converts

Kansas has become the seventh state to require health insurance companies, hospitals and other credentialing organizations to accept a standard physician credentialing form developed by the Council for Affordable Quality Healthcare, or CAQH.

A nonprofit collaborative of health plans, CAQH's mission is to improve health care access and quality and to reduce administrative requirements for physicians and other health care institutions.

Part of meeting that mission was the creation and promotion of the CAQH Provider Credentialing Application, a universal form that physicians can use for all health plans or hospital credentialing requests. CAQH is urging all state insurance officials to adopt the form, which can be completed online through the Universal Credentialing DataSource, or UCD, or downloaded from the UCD Web page, completed manually and sent to CAQH.

In addition to Kansas, Rhode Island, Indiana, Vermont, Kentucky, Tennessee, Louisiana, and the District of Columbia have designated or mandated use of the CAQH credentialing form.

Universal adoption of the form, however, would offer several benefits to physicians, according to Trevor Stone, private sector advocacy specialist in the AAFP Division of Practice Support. Among the benefits are

"The issue is when you have state-based credentialing applications that vary from the UCD," said Stone. "Some states still have their own forms that have state-specific questions, which creates duplication for the doctor."

More than 450,000 physicians now use the UCD service to share their credentialing information with more than 250 health plans, networks and other organizations across the country. More than 10,000 new providers sign up each month, according to Stone.

A uniform credentialing application would save thousands of dollars for physicians, according to the Medical Group Management Association, or MGMA. A 2005 survey (MS Excel file: 3 pages / 46 KB. More about downloading files.) by the MGMA Center for Research found medical practices submit nearly 18 credentialing applications per physician per year. Each application requires an average of 69 minutes of office staff time and 11.27 minutes of physician time to complete. The annual administrative cost for a 10-physician group to apply for credentialing totaled more than $7,600.

CAQH has advocated universal adoption of the form since May 2004, said Stone, adding that if Medicare adopted the CAQH process, the pendulum would swing in the direction of a single, national standard.

As a member of the Healthcare Administrative Simplification Coalition, a multi-stakeholder group that has focused on advocacy simplifying health care, the AAFP continues to support the UCD.