Paperless Credentialing Initiative for State of Massachusetts

1. Paperless Credentialing Initiativefor State of Massachusetts Presented by Andy Lock WIN/Staff, Inc. National Credentialing Forum 2004

2. Collaborating Partners

3. Primary Goals • Mass Medical Society received many complaints from physician members that paperwork associated with credentialing was getting overbearing. There was a problem to solve. • TriZetto wanted to lower costs and become more efficient without a major capital investment and long development cycle. • Interplan Health Plans wanted to offer their physicians a painless method to get recredentialed.

4. Requirements • Must be easy to use, completely paperless, and no cost to the physician for Interplan health plans. • Must include required data set and electronic signature acceptable under JCAHO / NCQA accreditation standards. • Data available electronically to TriZetto for automated interface to existing credentialing system. • Needs to include copies/images of supporting documentation such as DEA certificate, medical license, malpractice face sheet, etc. • Customizable to satisfy the individual needs of the health plans and hospitals.

5. The Solution • Make it easy for the Drs. 18,000 physicians’ were by pre-loaded into the application database to minimize data entry. • 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. • A custom data download was created for TriZetto to retrieve applications electronically. • Basic level of service is free of charge for submitting applications to Interplan. Option to upgrade to Premium for all credentialing needs. • Full document management is included in the electronic application with smart DocuLink technology which ensures every paper document is on file.

6. Network Architecture • Internal office network at practitioners and HCOs are separate from the on-line network. Confidential information such as medical records are fully protected. • WIN/Staff manages and protects all web-based data and network software so HCOs and practitioners only need browser to access. • A separate Web network improves security that is fine-tuned to protect sensitive data.

7. Data Security • Secure environment for access over the Web: • Security: SSL Certification, firewall design • Multiple Servers: Web / Application / Data • Redundancy and Load Balancing • Separate Secured Networks • Credentialing documents are not emailed because of inherent security flaws in most email programs. • Password and keyword data is encrypted so even our own employees do not have access to passwords.

8. Deployment Strategy • Application private-labeled under the brand name CredentialPlus.com. Marketed as a PIAM/MMS credentialing service. Custom CredentialPlus website and credentialing home page created. • Needed to offer more than just credentialing for TriZetto clients. We incorporated features to solve all credentialing headaches. • Partnered with physician organizations such as IPAs and PHOs, which had strong ties to their community of physicians and local hospital(s). • The participating healthcare organizations (TriZetto, health plans and hospitals) promote the service through their recredentialing notices and newsletters to physicians. • Presentations to MMS, MA Assn of Health Plans, and MA Hospital Assn.

9. CredentialPlus Private Labeled Websites Custom CredentialPlus private-labeled Credentialing application CredentialPlus Home Page

10. Participating Organizations Boston Eye Surgery & Laser Center Boston University Eye Assoc. Inc. Bournewood Hospital Brockton Multi-Service Center Cape Cod & the Islands CMHC Cape Cod Eye Surgery & Laser Center Cape Cod Hospital Everett House Carleton Willard Village Copley at Stoughton Corrigan Mental Health Center Dimock Community Health Center Dr. Solomon Carter Fuller Mental Health Center Eagle Pond Rehabilitation and Living Center Erich Lindemann MHC Everett House Eye Care Associates of San Diego Medical Group Fallon Community Health Plan Falmouth Hospital Franciscan Children's Hospital Greater Lawrence Family Health Center Harvard Pilgrim Health Care Harbor Health Services-Neponset Health Center Health New England HealthSouth Braintree Rehabilitation Hospital HealthSouth Rehabilitation Hospital of Western MA Holyoke Hospital Jewish Memorial Hospital & Rehabilitation Center MIT Medical Department Mayflower Place Nursing Center Mercy Medical Center Milton Hospital Morton Hospital & Medical Center Neighborhood Health Plan New England Pediatric Care New England Sinai Hospital & Rehabilitation Network Health Plan Noble Hospital Outer Cape Health Pioneer Valley Eye Surgery and Laser Center Primary Care Associates Medical Group Rehab Hospital of the Cape & Islands San Diego County Medical Society Saint Vincent Hospital Soldiers' Home Southeastern Area DMH Southern CA Physicians Managed Care Services State University of New York College of Optometry Taunton State Hospital The May Institute Tufts Health Plan UMass Memorial Hospital University Eye Care Network University Health Services Wedgemere Rehabilitation & Nursing Ctr. Whittier Rehabilitation Hospital-Haverhill Whittier Rehabilitation Hospital-Westborough Winchester Hospital Wing Memorial Hospital

11. 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.

12. The Key to Success:Practitioner Adoption • When implementing an on-line application system, keep the practitioner’s interest in mind. • 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. • With useful features and time-saving benefits, practitioners’ office staff will use it more likely then a service that has limited capabilities. Please direct any questions you may have regarding this document to Andy Lock at (858)274-6828 ext 205 or at alock@winstaff.com