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AmeriHealth Caritas Credentialing AmeriHealth Caritas PA AmeriHealth NORTHEAST Keystone First Joanne Dugan, Director of Credentialing.

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Presentation on theme: "AmeriHealth Caritas Credentialing AmeriHealth Caritas PA AmeriHealth NORTHEAST Keystone First Joanne Dugan, Director of Credentialing."— Presentation transcript:

1 AmeriHealth Caritas Credentialing AmeriHealth Caritas PA AmeriHealth NORTHEAST Keystone First Joanne Dugan, Director of Credentialing

2 Industry Trends Paperless credentialing process Manual to automated functionality Ongoing monitoring

3 Paperless Credentialing Process AmeriHealth Caritas worked with CACTUS and developed an automated custom program to attach the CAQH data to each providers’ individual profile Provider data is in one place Reduction in postage and paper 25% reduction in termination for non compliance

4 Manual to Automated Functionality CAQH Management Module - auto populates CAQH data into the providers’ individual profile in CACTUS ABMS Direct Connect – checks for board expiration, updates are provided through CACTUS Delegate Importer – auto populates delegate data into CASTUS from an EXCEL spreadsheet

5 Ongoing Monitoring Monitoring practitioners’ state licensure sanctions and limitations between credentialing events: – Automated License Expiration Monitoring Module/DEA Module – web crawler alerts coordinator when issue arises – includes repeated notices before and after expiration date and also updates new information when provided – NPDB Continuous Query – automatic notification via of any changes in a provider’s report for status – OIG Monthly Sweep – conducted through CACTUS – Quality Monitoring – Quality department notifies Credentialing of any quality of care issues – PA State Disciplinary Report – received monthly and imported directly into CACTUS – Preclusion Letters – upon notification from Regulatory Affairs, the letter is scanned directly into the Provider’ file

6 Thank you for your attention! Questions! You can me at:

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