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Paperless Credentialing Initiativefor State of Massachusetts

Presented byAndy Lock

WIN/Staff, Inc.

National Credentialing Forum 2004

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Collaborating Partners

1. PIAM Medical Services (a subsidiary of Massachusetts Medical Society)

2. TriZetto NCVO (a national CVO)

3. WIN/Staff (a software technology company

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Primary Goals

1. Mass Medical Society received many complaints from physician members that paperwork associated with credentialing was getting overbearing. There was a problem to solve.

2. TriZetto wanted to lower costs and become more efficient without a major capital investment and long development cycle.

3. Interplan Health Plans wanted to offer their physicians a painless method to get recredentialed.

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Requirements1. Must be easy to use, completely paperless, and no cost to the physician for

Interplan health plans.

2. Must include required data set and electronic signature acceptable under JCAHO / NCQA accreditation standards.

3. Data available electronically to TriZetto for automated interface to existing credentialing system.

4. Needs to include copies/images of supporting documentation such as DEA certificate, medical license, malpractice face sheet, etc.

5. Customizable to satisfy the individual needs of the health plans and hospitals.

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The Solution1. Make it easy for the Drs. 18,000 physicians’ were by pre-loaded into the

application database to minimize data entry.

2. PRO-FILE incorporates a superset of data including proprietary technology to record and store electronic signatures designed to specifications of JCAHO and NCQA accreditation standards.

3. A custom data download was created for TriZetto to retrieve applications electronically.

4. Basic level of service is free of charge for submitting applications to Interplan. Option to upgrade to Premium for all credentialing needs.

5. Full document management is included in the electronic application with smart DocuLink technology which ensures every paper document is on file.

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Network Architecture

Office Firewall

Office Computer

Office Computer

Office Computer

Office Server Local OfficeNetwork

Internet

Practitioners

Other HealthcareOrganizations

Web/ASPFirewall

SecureWeb Server

Data Server

1. Internal office network at practitioners and HCOs are separate from the on-line network. Confidential information such as medical records are fully protected.

2. WIN/Staff manages and protects all web-based data and network software so HCOs and practitioners only need browser to access.

3. A separate Web network improves security that is fine-tuned to protect sensitive data.

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Data Security1. Secure environment for access over the Web:

a) Security: SSL Certification, firewall design b) Multiple Servers: Web / Application / Datac) Redundancy and Load Balancingd) Separate Secured Networks

2. Credentialing documents are not emailed because of inherent security flaws in most email programs.

3. Password and keyword data is encrypted so even our own employees do not have access to passwords.

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Deployment Strategy1. Application private-labeled under the brand name CredentialPlus.com.

Marketed as a PIAM/MMS credentialing service. Custom CredentialPlus website and credentialing home page created.

2. Needed to offer more than just credentialing for TriZetto clients. We incorporated features to solve all credentialing headaches.

3. Partnered with physician organizations such as IPAs and PHOs, which had strong ties to their community of physicians and local hospital(s).

4. The participating healthcare organizations (TriZetto, health plans and hospitals) promote the service through their recredentialing notices and newsletters to physicians.

5. Presentations to MMS, MA Assn of Health Plans, and MA Hospital Assn.

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CredentialPlus

CredentialPlus Home Page

Custom CredentialPlus private-labeled Credentialing application

Private Labeled Websites

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Participating OrganizationsBoston Eye Surgery & Laser CenterBoston University Eye Assoc. Inc.Bournewood HospitalBrockton Multi-Service CenterCape Cod & the Islands CMHCCape Cod Eye Surgery & Laser CenterCape Cod HospitalEverett HouseCarleton Willard VillageCopley at StoughtonCorrigan Mental Health CenterDimock Community Health CenterDr. Solomon Carter Fuller Mental Health CenterEagle Pond Rehabilitation and Living CenterErich Lindemann MHCEverett HouseEye Care Associates of San Diego Medical GroupFallon Community Health PlanFalmouth HospitalFranciscan Children's HospitalGreater Lawrence Family Health CenterHarvard Pilgrim Health CareHarbor Health Services-Neponset Health CenterHealth New EnglandHealthSouth Braintree Rehabilitation HospitalHealthSouth Rehabilitation Hospital of Western MAHolyoke HospitalJewish Memorial Hospital & Rehabilitation Center

MIT Medical DepartmentMayflower Place Nursing CenterMercy Medical CenterMilton HospitalMorton Hospital & Medical CenterNeighborhood Health PlanNew England Pediatric CareNew England Sinai Hospital & RehabilitationNetwork Health PlanNoble HospitalOuter Cape HealthPioneer Valley Eye Surgery and Laser CenterPrimary Care Associates Medical GroupRehab Hospital of the Cape & IslandsSan Diego County Medical SocietySaint Vincent HospitalSoldiers' HomeSoutheastern Area DMHSouthern CA Physicians Managed Care ServicesState University of New York College of OptometryTaunton State HospitalThe May InstituteTufts Health PlanUMass Memorial HospitalUniversity Eye Care NetworkUniversity Health ServicesWedgemere Rehabilitation & Nursing Ctr.Whittier Rehabilitation Hospital-HaverhillWhittier Rehabilitation Hospital-WestboroughWinchester HospitalWing Memorial Hospital

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Status of Initiative•Actual launch date was September 1, 2003.•Hundreds of users managing thousands of physicians registered and using the system daily.•Physicians’ staff are praising the time-saving features of electronic paperless credentialing.•One IPA sponsored all their physicians’ upgrade to the Premium level of service and convinced their local hospitals to join the network as well.•TriZetto NCVO downloading hundreds of physicians applications monthly with major savings in time and money.•PIAM/MMS successfully planned and launched a value-added service for their members.

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Please direct any questions you may have regardingthis document to Andy Lock at (858)274-6828 ext 205

or at alock@winstaff.com

The Key to Success:Practitioner Adoption

1. When implementing an on-line application system, keep the practitioner’s interest in mind.

2. Practitioners want to know how it will make his/her office more efficient, not yours. Must provide a total credentialing solution for them, not a partial one just for your HCO/CVO.

3. With useful features and time-saving benefits, practitioners’ office staff will use it more likely then a service that has limited capabilities.