Credentialing, Enrollment and Creating a Partnership

1. Credentialing, Enrollment and Creating a Partnership Nancy Marotta, Sr. Manager, Provider Operations, BCBSMA, April 27, 2016

2. 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

3. 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

4. What we have done • We listened • We made changes • We instituted controls • We want to partner with you

5. 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

6. How we can Partner Better • Submit your requests to us in Email • Provider-Enrollment@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, don’t 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) • PA’s-supervising physician and NCCPA # so that we can verify • Any work history gaps over 6 months need to be in writing

7. 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.

8. 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

9. Business Operations Analyst – K Grade For more information • Contact • Nancy Marotta@bcbsma.com