Credentialing, Enrollment and Creating a Partnership

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Credentialing, Enrollment and Creating a
Partnership

• Nancy Marotta, Sr. Manager, Provider Operations,
• BCBSMA, April 27, 2016

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Provider Operations

• Credential and Recredential Physicians,
  Clinicians and Facilities
• Execute Provider Contracts
• Enroll Providers into our Claims processing
  systems
• Maintain Provider Data
• Provider Data is fed to BCBSMA Member directories

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We heard you and we agree with you!

• 2015 was met with many challenges
• Provider Operations underperformed
• We heard you
• Lost Inventory
• Long turnaround times
• Have to submit transactions multiple times
• Had to call or query us multiple times

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What we have done

• We listened
• We made changes
• We instituted controls
• We want to partner with you

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What we have done 

• Imaging, Index, automate inventory control
• Email Box for all receipts
• Auto Response (confirmation of receipt)
• Close the loop campaign,
• Email responses
• Early Credentialing Process
• Hire additional resources
• Single Credentials committee April 2016

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How we can Partner Better

• Submit your requests to us in Email
• Provider-Enrollment_at_bcbsma.com
• You will receive an auto confirmation response
  from BCBSMA
• Tip include in the subject line what is in the
  email
• Start the Credentialing Process early
• Email the form listing key data elements for your
  new physician(s)/clinician(s) being added
• CAQH just has to be started, dont wait for
  contracts to be ready
• Complete CAQH Avoid delays
• Hospital Affiliation Confirmations
• MCSR (state DEA where applicable)-especially on
  Optometrist
• Advanced nurses-collaborating physician,
  admitting arrangements and Certificates (ANCC or
  NCC)
• PAs-supervising physician and NCCPA so that we
  can verify
• Any work history gaps over 6 months need to be in
  writing

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How we can Partner Better

• Take the Guess work out of your Request
• Send a Contract Update form with every request
• Email the Contract
• We no longer return paper executed contracts
• Closing the Loop
• On your contract update form be sure to include
  the email address(s) you want the response to be
  emailed too.
• If it is not on your contract update form we will
  look for another on your request
• Lastly we will email our response to the practice
  address we have on file
• Member Directories
• Important to let us know if a provider leaves
  your organization and or if phone numbers or
  addresses change.
• For changes not involving a contract use the
  standard demographic form found on our portal
  at Bluecrossma.com
• CMS, NCQA and ACA all have come out with strict
  requirements on healthplans to ensure that
  directories are accurate for member usage.

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Other Updates

• Single Credentials committee structure, April
  2016
• 3 committees to one
• CPR and Credentialing are aligned
• Instituted weekly subcommittee meetings
• Credentialing Policy
• Board Certification/DEA/Reference letter
• Revisiting Foreign Trained Policy
• Credentialing Guidelines are on Bluecrossma.com

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For more information
Business Operations Analyst K Grade

• Contact
• Nancy Marotta_at_bcbsma.com