What Oregon’s New Provider-Credentialing System Means for Medical Staff Services Managers

What Oregon’s New Provider-Credentialing System Means for Medical Staff Services Managers
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Oregon’s new law establishing a statewide provider-credentialing system means big changes for medical staff services managers. The law, passed as SB 604, streamlines provider credentialing by establishing a centralized electronic database for credentialing organizations such as hospitals, insurance companies and other facilities.

What the Law Means

With this move, Oregon is the first state to mandate a single statewide credentialing system for medical providers.

When a health provider wants to join the medical staff or participate in a health plan, a medical staff services managers will be able to go into a database and get the information, as well as primary source material, says Ann Klinger, credentialing supervisor at Providence Health Plans in Beaverton. “They’ll have already provided their Oregon medical license, and we don’t need to bug the provider for it.”

The primary result for medical staff services managers is expected to be a decrease in paperwork and in the amount of time it takes to verify credentials.

What Details Still Need to Be Worked Out

However, the system isn’t finalized or online yet. Klinger says some details still need to be hammered out. “The nuts and bolts come next,” she says.

A working group is scheduled to start meeting the first week of October to work out some of the details. “How does it come together and what will be the true requirements, that’s the interesting piece -- what comes next,” says Klinger.

Other things that need to be decided are the vendor that will operate the system, fees to participate, standards and whether verification will be done at the time of registration or by the hospital or health plan. The standards the working group comes up with will need to stay within federal standards. The working group has almost 18 months to make these decisions.

“We’ll have to wait a bit to see how it’s going to help hospitals and health plans,” Klinger says. “What I’m hoping to see is maybe we won’t have as many gaps in information.”

What Medical Staff Services Managers Will Still Need to Check

While Klinger says there won’t be a need for primary sourcing, such as for the medical license, medical staff services managers will still want to double-check references, work histories and other information when they’re interested in bringing a provider on board.

As for the providers themselves, “it’s a very big benefit for them,” Klinger says. “It gives them one place to submit their applications. In most states, when you apply to multiple hospitals and health plans, you have to do the application multiple times.”

While there are other databases that keep track of credentialing, Oregon has been hoping to do something like this for several years. Some states have similar systems, but Oregon is the first to mandate a statewide database.

As the working group makes more decisions, medical staff services managers will need to stay abreast of any changes that take place. In the long run, though, it seems as though the database will save medical staff services managers time and effort.