Oregon to Streamline Provider Credentialing

Jacqueline Fellows, for HealthLeaders Media , August 22, 2013

Ryan also says Oregon's electronic system shouldn't replace outside provider credentialing organizations because outside verification makes good sense.

"I don't think it will completely remove the need… if they're doing it right," says Ryan, who also works with the Oregon Association of Medical Staff Services (OAMSS) to help steer the state toward how the mandatory system will operate.

The Oregon Health Authority (OHA), which oversees the state's public health plan as well as its children's health insurance program and employee benefits, is tasked with working out the technical details of the system.

Tom Holt, director of government affairs for Regence BlueCross BlueShield in Oregon, says there are two legislative sessions between now and the due date for Oregon's system, and while the operational minutiae are getting worked out, he expects the end result to benefit all parties who touch the credentialing process, including insurance companies like Regence.

"From our point of view, the win is simply taking the friction out of the administration of healthcare," says Holt. "Every health plan, [and every] hospital, has something that they're using. In an ideal world, there'd be one central place. For here it makes sense. We have a uniquely collaborative culture."

Jacqueline Fellows is an editor for HealthLeaders Media.
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4 comments on "Oregon to Streamline Provider Credentialing"

Kendra (8/30/2013 at 4:05 PM)
Arkansas has had a mandate to for all hospitals, insurance companies, and other facilities to use CCVS(Centralized Credentialing Verification Service)since January 1,2002. I'm glad to hear other states are doing the same.

Elizabeth (8/28/2013 at 5:19 PM)
bettynoyes: Credentialing isn't something that is subject to commentary or opinions. The credentialing process has to do with validating a professionals, credentials. Whether or not their license is valid does not require commentary. There are other parts to the process of, say, hospital medical staff appointment and privileging which DO take into account peer references, clinical peer review data, practitioner's health and ability to play nice with others, etc. Those somewhat more ephemeral qualities would probably not be part of a credentialing database. Then there are other aspects that are investigative and somewhat subjective. Criminal background check, NPDB check, Google check and on and on. Maggie: I'm with you, I'm very curious about the particulars of this database. I live and do credentialing in TX so only a matter of interest to me. Oregon may start a trend.

Maggie (8/27/2013 at 2:39 PM)
I'm happy to see the legislature involved those who acutally perform the work...the Medical Services Profession (CPCS/CPMSM). I'm wondering if this similar to the CAHQ application ~ a central repository for data ONLY and the credentialing (PSV) would still be performed by each organization. Or will it be data AND PSV documents? Who validates the data or updates it? What about the organizations that spent tens of thousands of dollars on their own software? Will the data interface and what is the cost? I guess I have a lot of questions don't I? (even that was a question =) I'll go read the bill.




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