Credentialing Data General Information FAQs
The following is a list of questions or comments shared with OneHealthPort about the Credentialing Data Management project, this information is updated whenever new questions are submitted.
Start Dates, Orientation, Information, Communication:
Upload/interface with credentialing software vendors: Digital Signatures: Data Integrity/Attestation: Master Data Collection and Updates: Data Availability: Other Concerns: Historical Questions
In 2009 State Senate Bill 5346 was passed which includes a requirement that the Insurance Commissioner oversee the appointment of a private sector
lead organization to manage the selection and implementation of a statewide provider database to collect and share information for credentialing, privileging and other uses.
The lead organization named was OneHealthPort. The vendor selected was Medversant and their application that collects provider data and allows the practice organization to manage
all provider data is ProviderSource. The global service operated by OneHealthPort to manage sharing the data collected is called Provider Data Service.
Your practice can enter data and manage practitioner records in the ProviderSource application you will reach from a link on OneHealthPort. The application is free for provider organizations and uses your OneHealthPort login. Organizations who need your data will contract with OneHealthPort
Provider Data Service to get data for credentialing and privileging.
New Questions - posted December 2, 2010
Start Dates, Orientation, Information, Communication:
Providers can enter data anytime they wish now that the Service is open. They will receive regular notices from hospitals and health plans when they are looking for information for the next re-credential or privileging event. Nothing about notifications from hospitals and health plans has changed, the data will be picked up from the ProviderSource application once completed and attested and needed by an organization for their workflow.
Organizations are expected to notify providers in advance of their need for completed records and login to Client Portal application to request and download completed records. The organization must be contracted with OneHealthPort to access Client Portal.
The concept in SSB 5346 is that voluntary adoption rather than regulation is the best approach to make change universal. That is not the same thing as a purely voluntary model where each organization can decide whether to adopt or not. The intent of the Legislature is clearly that all hospitals, health plans and providers adopt the requirements of SSB 5346. If this universal adoption does not occur voluntarily, the bill authorizes the OIC to take a regulatory approach.
Systems have been operational since November 3, 2010 for providers and OHP Administrators to enter and manage provider data.
OHP has emailed all OHP users and posted messages on the website multiple times over the last few months. OHP shared a message with all contracted hospitals, health plans, WSMA and WSHA who have also been spreading the word to the provider community. WAMSS has also been provided the information to share with their members and OHP has attended three WAMSS events around the state in person to make sure the association is getting information and has plenty of opportunity to ask questions. OHP has attended MGMA, WSMA, Pharmacist and Physician Executive conferences where demonstrations and information was shared.
OHP's message focuses on explaining when the application is available and the basics of getting started. There is a full web page (Click here to go to web page) that contains videos and instruction sheets for getting started. This information has been updated each month to reflect where the project was and what to do while we were waiting for the new application to be ready. Health Plans and the WSMA and WSHA have also published updates to their members and OHP has met with groups at the request of both associations. OHP added a feedback link on the ProviderSource information page after Go-Live so users could offer feedback direct to OneHealthPort and Medversant.
OHP has used its own messaging and the messaging of the hospitals, Health Plans and associations to spread the word. Individual organizations that Credential and Privilege providers are responsible for notifying the providers when they need their information, by when and reminding providers that data collection is through the FREE ProviderSource application on OneHealthPort.
Brief training videos are available on the OHP ProviderSource information web page. There are also printable documents and a WPA for those who need to gather information before they get started inputting data. There are online help and field-level information buttons in the ProviderSource application to assist in answering questions as data is being entered. The Feedback survey asks for additional ideas on what would be helpful to assist users doing data entry and document attestation.
The requirements are a computer with a web browser, an Internet connection and a OneHealthPort UserID.
Hospitals and Health Plans will receive documentation and a video tour of the Client Portal when that application is completed and ready for use. OHP has offered several demonstrations of the prototype and is awaiting the final application during December 2010.
OneHealthPort offers first tier technical support via the 24x7x365 call center for providers and administrators. If there are application questions, ProviderSource has been responding appropriately.
The law defines "health care providers" as it is defined under RCW 48.43.005 and it also expressly includes facilities as defined in RCW 70.41.
Yes, CAQH was an unsuccessful bidder for this service during the RFP process. OHP offered to exchange data with CAQH for its customers in Washington State. However, CAQH decided not to do so. Therefore, all data collection in Washington State for credentialing and privileging purposes will be through this Provider Data Service.
Yes, all commercial and public payers requesting information from Washington State practitioners must make their requests through the Provider Data Service.
Yes, any healthcare entity collecting data for the purposes of credentialing or privileging a provider falls under this law.
It is not OHP's role to determine regulatory responsibilities. The Legislature assigned responsibility to the Office of the Insurance Commissioner for enforcement and oversight of SSB 5346. OHP's reporting responsibility is to OIC and the Legislature. The OIC has indicated to us it believes it has the authority to regulate hospital adoption of the provisions of SSB 5346. The Legislature has also made it clear to us that it expects universal adoption either through voluntary adoption or if that fails regulation.
Upload/interface with credentialing software vendors:
OHP is working with Medversant to publish a process for loading standard files from other systems to save large organizations time in loading data. The standard file format has been available for several months, the process to request access to load data and a secure file transfer process is being finalized and tested now and should be available in December 2010 for interested organizations. OHP will publish a request form on the OHP website for interested organizations to sign up for file loading with Medversant.
There are multiple options available to hospitals and health plans for how they can receive the data they purchase. Data can be downloaded as files or requested as a web service. Custom data triggers can also be purchased based on events like license changes or key data changes.
The Legislature wrote the law and presumably considered a blend of cost and benefit issues when they authored the bill. OIC and OHP recognize that all change, even positive change carries costs. However, maintaining the status quo also imposes costs. We appreciate the costs and challenges incurred by all parties, those dealing with the current system and those attempting to make improvements.
Digital Signatures:
The States cannot legislate a Federal program to participate in a state process. Medicare is not required to participate. In the event Medicare opts to participate, the then current federal standards would be reviewed.
Data Integrity/Attestation:
The latest attested data is the most current record and should be trusted. Only the provider can attest to their data so there should not be more than one version of the most recently attested data once providers enter their data in the ProviderSource application. The ProviderSource application checks primary sources before the record is released for use and promts the provider to correct any differences in their record.
Providers are asked to attest to their data at least once every 150 days or when fields that require an attestation are changed. Not all fields require an attestation so minor changes to records will not trigger a new attestation.
The Provider Source application will notify the provider or the person they have designated for notices. If they or an administrator are in their account, the application will notify them if a record change now requires an attestation update.
All systems are vulnerable to some degree. It is not possible to ensure perfect security in the OHP system or any other system. However, the OHP system is designed to minimize risks. The OHP system does not allow the Administrator to see the password of the subscribers they nominate. The administrator nominates the user and shares a one-time use activation code with the provider who uses that code to complete their account setup, set a password and select and answer secret questions. The user also accepts a user agreement that says they are the person the identity is being requested for. If they falsely attest and create the providers identity for them, they have committed fraud. The system logs the user ID of the person doing the attestation; if that person has lied or has shared their password then they are committing fraud and can have their identity revoked. The system cannot detect when a user is lying but that does not mean the system is out of compliance, the user is and once discovered the user is liable for any damages. The organization also has responsibilities for its administrators so if there is a breach of identity then the user and the organization can be held liable. Most organizations realize this and have policies that guide their staff and administrators to minimize risks for the organization.
Master Data Collection and Updates:
Within the PDS, OHP is responsible for maintaining the Washington Practitioner Application as the primary document for data collection in Washington State. OHP works with WAMSS to ensure OHP is aware of changes to the WPA for updates to the ProviderSource data collection process.
OHP is not responsible for Medicare requirements but for the collection of the WPA application.
There is no provision in the law for non-standard data collection and no mention of this checklist in the Washington Practitioner Application. Besides the WPA, data is collected for NCQA, Joint Commission and URAC requirements based on custom contracts.
For now the provider is responsible for making sure their information is accurate, complete and updated. The ProviderSource application checks the Washington State Dept of Health licensing status and will notify the practitioner during the application audit if it finds different information than what the provider has supplied. In 2011 OHP will work with the Dept of Health on interfaces with the Medversant application. At this time we do not know the extent of the interface that may be developed.
Providers will receive notice reminders for information such as license and insurance renewals where a field collects the data about the next renewal. Organizations released to receive the data will have the option to pick the data up for themselves when they are checking records or pay additional fees for custom triggers to be notified of record updates.
Administrators can see how much is completed for a provider record in their organization. Organizations waiting for the record to be ready for pickup can see basic status but cannot view or download the record content until it is complete and fully attested
Data Availability:
The record is ready moments after it is attested.
One of the final pages before attestation allows the provider or their administrator to select all the health plans they wish to release their records to. Hospitals listed in the affiliation section are also included on the release list and can be selected or unselected for record sharing. There is also a selection to allow OneHealthPort access to non-confidential data for use by the Washington State health Information exchange.
The Data Policy indicates the confidential portions of the record can only be shared with organizations specifically doing credentialing or privileging for that specific provider as assigned by that provider. OneHealthPort has identified use of the non-confidential data to populate the Statewide HIE Provider Directory and asks permission for this use in the data release section of the application. Other uses of the non-confidential data are allowed but have not been identified to date.
Other Concerns:
We respect your position. However, that question is no longer on the table for debate. The Legislature acted and included privileging in the bill. We are obligated to make our best effort to implement the law as written. SSB 5346 requires data collection for credentialing and privileging is through a common process. The data collection can be more standardized while maintaining individual process and committee work for each organization. The law does not change the privileging process nor does it impact the privileging decisions made by individual facilities or organizations.
If WAMSS wishes to create a separate data collection for reappointments similar to the WPA, OneHealthPort will work to verify this meets the community need and gets incorporated in the data collection process.
The ProviderSource is a good solution for data collection for Locum tenens since data is available when you need it. Additional reference verification is available at a custom price and can be requested by any organization.
While we understand the concern about jobs and outsourcing overseas we have no role in determining the personnel decisions of any individual organizations. However, it is important to understand that the Medversant contract requires that all jobs are performed in the Unites States.
Historical Questions
Any hospital, health plan, payer or third party organization doing credentialing or privileging can subscribe to the Provider Data Service to purchase a copy of your data collected by the ProviderSource application. There is no geographical limitation. Confidential information can only be
purchased for credentialing and privileging uses. Click on the link to find out more about pricing and contracting for the Provider Data Services.
This will replace CAQH as the standard provider data management source for all health plans and hospitals in Washington State. Once you have entered data in the Medversant system, you can stop entering it in the CAQH system.
No, there won't be a data transfer from CAQH to Medversant because there are differences in the data. Some of your data will be pre-populated based on the Medversant technology that crawls the Internet to find your data. This will require that your practice enter any missing data and all pre-populated data must be
reviewed and verified to confirm it is the most current information.
Your practice will have a new way to store and manage all your provider data and reduce the hassles of paperwork and forms from 12 different payers and 4-5 different hospitals or whatever the numbers work out for your practice.
The provider community helped craft the language in SSB 5346 based on the frustration with the current repetitive paper process for credentialing and privileging.
NO, this does not change the process each individual payer, hospital or other credentialing and privileging organization must oversee. This new service simplifies the collection of the data and documents. This also gives us an opportunity to look for ways to
further improve the process and other uses of the data.
The ProviderSource application collects data and required additional documents (copy of your license, copy of your driver's license, etc.) for use by staff doing the credentialing process for payers, hospitals and other organizations. It simplifies management of your data and documents.
The service does NOT replace the process and committee approvals at each individual organization that does credentialing. It does not change the communications those organizations will need to have with you around credentialing.
The practitioner record will be used to collect all the common data. OneHealthPort is working with hospitals to help simplify the very complex process of data collection for privileging. Because that
process can be very different at each hospital or health system, the initial process will focus on simplifying access to the required forms for each hospital. You will need to fill out the individual forms and load them into the document library. Once loaded you will also need to "affiliate" them with a specific facility so they can access those documents. There will be
more detailed information about privileging documents during July as we fine tune that less standardized data collection process.
Any licensed healthcare practitioner who is credentialed or privileged by a health plan, payer, hospital, TPA or care organization will now input all data and documents into the ProviderSource application.
The organization scheduling the re-credentialing or privileging work will notify the practitioner of the process and any additional documents they will need completed and loaded into the ProviderSource document library.
The ProviderSource application is a free service that allows practitioners and their organizations to manage the data and documents needed for Credentialing and Privileging. There is no charge for practitioner use for data management.
Organizations wishing to use the data for credentialing and privileging will contract and pay through the Provider Data Service managed by OneHealthPort.
There will be online training videos you can watch at any time, FAQs in the application, help menus and mouse-over explanations in the application and webcasts to provide an overview.
Once the ProviderSource application is live, you can start entering data at any time. We will announce when the service is open for data entry. Or you can wait for a request from a payer or hospital based on an upcoming credentialing or privileging requirement.
The ProviderSource application is linked to the OneHealthPort security service and will accept your current OneHealthPort user ID and password. There is no additional registration or setup required.
The OneHealthPort login is free. If someone in your practice is already using OneHealthPort then you need to find your OneHealthPort administrator and they can nominate you for a login. If your office has not registered with OneHealthPort, click here to register for a OneHealthPort login
The application is very secure using all the latest in security. Access to the individual records for inputting and editing data is based on users in your OneHealthPort organization. A OneHealthPort administrator for your organization determines who can see and
edit records on your practitioners. Individual practitioner records are tied to a OneHealthPort login since the practitioner will need to verify the final record and attest to it with a digital signature in the application. Any organization wishing to purchase
the data must verify their identity and use with OneHealthPort.
The OneHealthPort Provider Data Service Policy outlines the principles for sharing data.
Yes, the practitioner or their data entry designee will be able to print the document. The data will be stored and can be re-visited at any time for edits and updates. In this first year of transition to the new services, hospitals and health plans may request
a paper copy of the document until they are able to connect and pick up the electronic data direct from the Provider Data Service. In 2011, all requests from payers, hospitals and others should be for electronic data in the ProviderSource application.
The practitioner can designate one or more persons to manage their data entry and document management. The practitioner can not delegate the final attestation to the record, that must be done by the individual practitioner.
Yes, there will be a standard record format and the ability to upload a file. This file upload will not cover the complete record so additional data entry may be needed to complete the practitioner file.
OneHealthPort has proposed attestations be required every 150 days to meet national credentialing requirements. Some organizations would like the attestation to be every 90 days so data and records are current and available whenever needed. The initial requirement will be 150 days with reminders to the "alerted" contact when it is time to re-attest.
Staff can do all the prep work to update the records at any time but the practitioner will be required to do all attestations for them self.
The ProviderSource application can capture all the data you need to meet needs of any organization. If the organization does not pick data up electronically, you can print and sign a document to share with them. SSB 5346 requires all payers, hospitals and other credentialing and privileging organizations regardless of their state or national status to
participate by 2011 so that paper documents can be minimized. SSB 5346 applies to your practice in the State of Washington. If you have practice locations in another state, you need to comply with any requirements set by that state. The ProviderSource application will ask which states the practitioner is licensed in and add questions to cover requirements in individual states.
The ProviderSource application has a document management library. You will be directed to upload documents and store them in the system. This allows you to save them in a secure space and update them if needed over time.
This also allows the organizations who need them to have access to them without bothering you to send and resend them.
In the ProviderSource application you will have a chance to set up the health plans you wish to share data with and the hospitals and facilities you affiliate with. You will be able to update this information at any time. Only organizations you have permitted will have access to your confidential data.
Yes, in the ProviderSource application you will be able to setup information about multiple practice locations and select which one is your primary practice location.
Yes, each practitioner will need an individual NPI number since the system indexes records on this unique number. If you don't have a NPI number, you can
complete the application online at https://nppes.cms.hhs.gov
The ProviderSource application should be used by any licensed healthcare practitioner who is required to be credentialed or privileged by payers, hospitals or other healthcare entities.
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