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Physician Credentialing
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Physician credentialingthe process of evaluating the qualifications and practice history of a physiciancan sometimes take as long as six months, sidelining and frustrating physicians, and creating barriers to patient care.

As part of its Healthy Doctors, Healthier Patients initiative, the WSMA successfully advocated in 2016 for legislation (House Bill 2335) that, for the first time in our state’s history, streamlines and standardizes applications and limits the turnaround time for insurers to approve or deny those requests*.

As a result, starting June 1, 2018:

  • Insurers must credential physicians and other providers within 90 days (and an average of 60 days, beginning in 2020).
  • Insurers, physicians and other providers must use ProviderSource to submit and process credentialing applications.

Background

Two major problems exist with insurers' credentialing systems, both stemming from a lack of standardization. First, each insurer has a unique process that requires some, but not all, of the same information from physicians. A physician contracting with 15 insurers in our state must complete each company's respective credentialing process—a time-consuming endeavor. Second, it may take months for an insurance carrier to approve an application, preventing physicians from providing care to their patients in those networks—and from earning an income—for a good portion of a year.

The process

Starting in June 2018, you must submit applications to insurance carriers via ProviderSource, a free health care credentialing tool operated by OneHealthPort, the state's lead organization providing health information techonology. ProviderSource will allow you to build a comprehensive professional profile, which also functions as a secure, universal credentialing and enrollment application. Once submitted, insurance carriers will have 90 days to approve your application. Note that 90 days is the ceiling; as all parties are required to use ProviderSource, we anticipate a reduction in the back-and-forth that tends to slow this process down, resulting in faster turnaround times.

Getting started

Visit OneHealthPort's credentialing webpages for step-by-step instructions for setting up your profile before logging into ProviderSource. Be sure to review the training videos and guides also provided by OneHealthPort to make sure you understand how to use all of the ProviderSource features.

Are insurers allowing your practice to benefit from the new requirements?

With the provisions of HB 2335 now in effect, are the insurers you contract with using ProviderSource to credential your physicians and other providers within 90 days? If the answer is “no":

Download a template letter, developed by the WSMA and the Washington State Medical Group Management Association, reminding reluctant insurance companies to follow the law and allow your practice to benefit from the legislation. After downloading, simply plug in your practice information and send the letter to your contact at each insurer with which you contract.

With insurers and physicians using ProviderSource, the hope is to make the credentialing process easier for small to midsized practices that do not benefit from delegation arrangements*. We are interested in hearing whether insurance companies are complying with this law and the details of their responses. Please email Jeb Shepard, associate director of legislative and regulatory affairs, at jeb@wsma.org with your feedback.

*HB 2335 does not apply to hospitals or medical groups with delegated credentialing arrangements.

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