Synergy - July/August 2014 - 22

MANAGED CARE CONNECTIONS

The articles in Managed Care Connections address readers' concerns
on many topics related to managed care organizations (MCOs), and they
are written by managed care professionals and other sources that affiliate
with MCOs. Interested in contributing to this section? Contact SYNERGY
Managing Editor, Kelly Rehan, at krehan@namss.org for details.

Amy Meyer has been with
the Cedar Rapids Physician
Hospital Organization
since November 2009 and
is currently the Senior
Credentialing Coordinator. She
has a BA degree in Business
from Mount Mercy College
in Cedar Rapids, Iowa, and
received the NAMSS CPCS
certification in October 2012.

Improving Processes and
Results Through Collaboration
By Amy Meyer

"Why do I need to make six copies of my
state license?"
"Why am I answering the same questions
over and over again?"
"How many times do I have to write down
where I went to medical school?"
"You want me to sign more stuff?"

H

ow many of us have heard things
like this (or worse!) from a new
physician coming to your town to
start practicing?
Here's a bit of background information:
The population of Cedar Rapids, Iowa, is
approximately 128,000 with two hospitals,
a surgery center, and a continuing care
hospital in town. Each facility has its own
privileging application and processes to
follow. The Cedar Rapids Physician Hospital
Organization (PHO) is currently delegated
for credentialing by 12 commercial
insurance payers. We have more than 760
member providers and facilities for which
we manage the payer contracting and
credentialing processes. If a new physician
wants to be credentialed for billing purposes
at a clinic in Cedar Rapids and have
privileges at all four facilities, they will need
to complete five separate applications and
provide a variety of documents to us at the
PHO along with the four facilities.
After hearing the pain in a physician's voice
one time too many, we at the PHO decided
to find a way to improve this process.
In early 2012, we began collecting copies
of the four major facility applications and

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combing through them to find duplicate
pieces of information requested and
questions asked. Would you believe that
there were more than 750 pieces of
information that a physician would be
required to fill in or answer among the four
facility applications and our own, much of
which was duplicative? No wonder we had
such frustrated physicians!
Many hours of work went into the
development of our "Super Application."
We had to determine what information
should be collected from all providers versus
providers who would need hospital forms
completed-we didn't want anyone to be
filling out unnecessary forms. We created
additional fields in our database to store the
new information we planned to collect. We
worked with our software company to design
forms to mirror the hospital applications,
which would be populated directly from
our database, and to edit our application
form. The end result was a slightly larger
PHO application and a supplement. All PHO
providers complete the main application; only
those who need hospital forms complete the
smaller supplement. Any question asked on a
hospital form is included, word-for-word, on
either the PHO application or the supplement
so that the provider has answered it, and we
can populate the answer for them on the
actual facility form.
Both applications are completed and
submitted on our secure website. The
information is imported into our database,
and we begin the payer credentialing
process internally. We also populate the
hospital forms for any applicable facilities
Synergy - July/August 2014

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