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Universal Provider Datasource: An Industry Standard for Practitioner Data Collection February 2009

Universal Provider Datasource: An Industry Standard for Practitioner Data Collection February 2009. 012709. An Industry Standard for Practitioners.

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Universal Provider Datasource: An Industry Standard for Practitioner Data Collection February 2009

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  1. Universal Provider Datasource:An Industry Standard for Practitioner Data Collection February 2009 012709

  2. An Industry Standard for Practitioners Nearly 690,000 unique practitioners have already registered with and are using the system (with nearly 10,000 new practitioners registering monthly).

  3. A Standard that Works - Practitioner Utilization • Breakdown of Standard vs. Allied and Ancillary Practitioners • Of the 690,000 registered practitioners, 476,000 are standard practitioners and 214,000 are allied and ancillary practitioners • Complete practitioners and percentage with current attestation • 626,000 practitioners have completed applications • 76% of completed practitioners have current attestations (120 days or less) • A study of UPD transactions over a 20 month period (January 2006 through August 2007) confirmed that practitioners utilize the UPD routinely and update information frequently • Practitioners routinely access the system • 383,911 unique practitioners attested 1,798,729 times • 4.7 attestations per practitioner out of a potential 5 attestations • Update information frequently • 1,100,031 (61%) of the attestations were accompanied by data changes

  4. Community Choice Michigan Community Health Care Network Coventry Healthcare Deaconess Health Plans Elder Health, Inc. Empire HealthChoice Excellus Health Plans The First Health Network / CCN Network Group Health Insurance of New York (GHI) Great-West Healthcare HealthLink, Inc. Health Net, Inc. HealthPlan of Michigan HIP Health Plan of New York Horizon BCBS of New Jersey Humana / ChoiceCare Network Independence Blue Cross Independent Health Kaiser Foundation Health Plan of the Mid-Atlantic States Lovelace Health System, Inc. MagellanHealth Services MAMSI Health Plans Martin’s Point Health Plans Mercy Health Plans Medical Mutual of Ohio An Industry Standard for Payer Organizations Nearly 500 participating health plans, networks and other organizations, including: • Molina Healthcare • MVP Health Plan • National Capital NCPPO • OptiCare • Oxford Health Plans, Inc. • Parkview Health Plan Services • Preferred Care • Priority Health • Rocky Mountain Health Plans • Sentara Healthcare • Suburban Health Organization of Indiana • Sutter Medical Foundation of California • Synergy Health Network • Triad Healthcare • UniCare • Unified Physicians’ Network • United Healthcare • United Behavioral Health • Univera • Virginia Premier • WellCare • WellChoice • WellPoint • XL Health • Aetna, Inc. • Affiliated Healthcare, Inc. (AHI) • AmeriChoice • AmeriHealth • Anthem Blue Cross and Blue Shield • Arnett Health Plans • AultCare • AvMed Health Plans • BCBS Florida • BCBS Georgia • BCBS Kansas • BCBS Kansas City • BCBS Michigan • BCBS Missouri • BCBS North Carolina • BCBS Western New York/HealthNow • BCBS Wisconsin • Blue Cross of California • Capital District Physicians' Health Plan • Care1st of Arizona • CareFirst BCBS • CareSource • Centene Corporation • CIGNA HealthCare • CIGNA Behavioral Health

  5. An Emerging Standard for New Users and Uses • Hospitals starting to participate – currently 39 hospitals are using UPD • Through the Vermont Hospital Association, its 13 members are now UPD participating organizations • KS and RI are also considering participation through association agreements • Individual hospitals in several other states have started to participate and more are recognizing and reviewing the UPD value proposition • State Medicaid agencies exploring participation • PA and KY Medicaid agencies expected to sign participation agreements shortly • VA and NY Medicaid agencies reviewing participation • Emergency Responder Registries • CAQH is exploring the use of the UPD to enable practitioners to volunteer as Emergency Responders and electronically forward their data to designated state ESAR-VHP registries • CAQH is working with the Massachusetts System for Advanced Registration (MSAR) program to use the UPD as a practitioner outreach and data collection tool for the program • Practitioner Opt-In Module • Future system enhancement that will allow practitioners to elect to participate in various initiatives or data exchanges with participating organizations – this will allow the collection and exchange of specific additional data/information relevant to specific initiatives

  6. An Emerging Standard for States • A growing number of states have addressed their local credentialing concerns by supporting the national standard application promoted by CAQH. These states are: • District of Columbia, Indiana, Kentucky, Maryland, Missouri, Ohio and Vermont: Adopted CAQH application as their own mandated form • Louisiana, New Jersey and Tennessee: Require or allow health plans to use either the standard CAQH application or a state-specific alternative • Kansas and Rhode Island: Insurance Commissioners have agreed to promote voluntary statewide adoption of CAQH application • New York: Rejected mandating a state specific application because the CAQH application was enjoying widespread voluntary adoption • New Mexico and Washington:Ongoing discussions regarding CAQH application

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