AzAHP Credentialing Alliance

May 2012

Goal:

To reduce the burden of credentialing currently placed on Arizona providers.

P A R T I C I P A T I N G P L A N S

Care1st Health Plan Arizona CMDP Health Choice Arizona Maricopa Health Plan Mercy Care Plan Phoenix Health Plan SCAN Health Plan Arizona United Community and State (APIPA) University of Arizona Health Plan

ALL Arizona business lines (AHCCCS Acute/ALTCS, MA PD, D-SNP, Commercial).

Together we represent over 1,115,000 members and over 15,000 unique providers.

Plans DO NOT need to be a member of AzAHP to participate in the alliance.

S T R U C T U R E

HEALTH PLAN HEALTH PLAN HEALTH PLAN

O P T U M I N S I G H T

Nation’s largest CVO Approximately 550,000 credentialing events/year Alliance experience Certified by NCQA, accredited by URAC, compliant with

JCAHO standards

S H A R E D C O M P O N E N T S

Initial Credentialing Site visits (PCPs & OBGYN) Re-credentialing

Both practitioners (includes dental) and facilities/organizations

Utilizing CAQH for practitioner applications

Plans retain control over network decisions and their credentialing committee

I N I T I A L C R E D E N T I A L I N G

Practitioners joining existing groups New practitioner/practitioner group

R E - C R E D E N T I A L I N G

Plan specific re-cred date Dr. John Smith

• PLAN A: 4/17/2014• PLAN B: 7/10/2013• PLAN C: 1/20/2014

Alliance re-cred date: 7/10/2013

C U R R E N T A C T I V I T I E S

Contracts• OptumInsight• CAQH• Plan Participation Agreements

Workflow definition/Statement of Work Network extracts from Plans to Optum due May 17 Provider communication campaign Delegated oversight process & pre-delegation review

Expecting the implementation to begin in June and LIVE September 2012

Questions

AzAHP Credentialing Alliance

May 2012

Scott Cummings

scummings@care1st.com

602.778.1860