(Delegated Credentialing for ACOs… continued) both the plan and the delegated entity • The assessment and evaluation of the credentialing program provides the plan with all the information required to determine whether the proposed entity meets plan standards • Ongoing oversight ensures that the delegated entity continues to operate in a compliant manner Some plans will delegate immediately upon review and approval of the entity’s program, and others will request that the program operate for a period of time prior to granting delegation. Plans will want to see how providers have moved through the group’s process and how outliers are reviewed. They will review policies and procedures related to credentialing and minutes from committee meetings. Once delegated, the group is responsible for credentialing and re-credentialing each provider for every plan to add participating group members to payor directories. The entity may also sub-delegate portions of the credentialing review process to a credentials verification organization (CVO). NCQA certifies CVOs to ensure they are processing credentials appropriately and that sanctions are monitored between credentialing cycles. NCQA facilitates oversight of the plan if it has evidence that a group is contracted with an NCQA-certified CVO. The group retains the committee approval process but does not need to employ staff dedicated to the credentialing process. Provider demographics are submitted at least monthly to the plan (delegation rosters) to be loaded as “participating under a delegated credentialing arrangement.” Demographic changes are managed through the roster process, as is communication when a provider leaves the group. It is important to note here that when the provider leaves your client’s group, they are no longer credentialed by the plan and must be credentialed in the traditional manner with their new practice unless they too have delegation. A group remains delegated as long as they continue to meet the requirements of the delegation program. Delegation does not replace the need for a group or individual A More Secure Way to store files 12 HBMA BILLING • JULY.AUGUST.2014 500+ medical billing offi ces nationwide use eBridge’s HIPAA-compliant, secure cloud-based document management system to streamline operations, save money, and reclaim space. t Provider scanning and retrieval t Eff ortless work queue management t Quick and easy batch scanning t Compliant audit trails to track user access t Full-text keyword searches for ultra-fast retrieval Call 813-387-3870 today for a demo. Because your business is about more than just paper. www.eBridge.com 813-387-3870 LHaywood@eBridge.com
Billing_JulAug14
To see the actual publication please follow the link above