Skip to main content

Oregon to Streamline Provider Credentialing

 |  By jfellows@healthleadersmedia.com  
   August 22, 2013

A new law requires the Oregon Health Authority to establish an electronic database for credentialing organizations, including hospitals, insurance companies, and other facilities.

Provider credentialing in Oregon is on its way to becoming more streamlined under a bill that mandates healthcare providers use a single credentialing system by 2016.

The initiative, known as SB 604, requires the Oregon Health Authority to establish an electronic database for credentialing organizations, including hospitals, insurance companies, and other facilities. It's the first state to mandate the use of a single credentialing system; the bill was overwhelmingly supported in the state legislature.

The bill was signed by Oregon governor John Kitzhaber (D) on July 1 and goes into effect Jan. 1 2014.

Jean Steinberg, CPCS, CPMSM, director of medical staff services for Bend, OR -based St. Charles Health System, says the idea to have a statewide database for credentialing and recredentialing providers has been in the works "for years."

"Oregon already has a mandated credentialing application, so this is the next logical step," says Steinberg. "We, in this day and age, should be way down the road with credentialing."

One reason for the setback, at least in recent years, was the focus on implementing the Patient Protection and Affordable Care Act, says Tom Holt, director of government affairs for Regence BlueCross BlueShield in Oregon. Holt says Regence BCBS supports the pending mandate.

"The problem has been on the radar for several years," says Holt. "It was stuck because most of the key players were, over the last two years, very much involved in Oregon's Medicaid reforms and now the [health insurance] exchange. So, projects like this got set aside."

State Senator Alan Bates, MD, a practicing physician, resurrected the initiative, which passed unanimously in both the state house and senate.

Steinberg is optimistic because Oregon's lawmakers took the significant step of making its system mandatory instead of voluntary, which is the case in the neighboring state of Washington.

"When you don't require something, and it doesn't get used, you're not really making a difference," she says.

Steinberg says her counterparts who participate in Washington's electronic credentialing system complain about the software program used to run it. That detail is one Steinberg hopes Oregon will get right.

"That's where the key lies here with us in Oregon… to get the best electronic system," says Steinberg.

The state has nearly 18 months to decide on the vendor, user fees, and how much vetting the system will do. It's unclear if the information entered about a physician will go through an initial, cursory validation check, or if it will be taken at face value, which would then require the healthcare facility to continue to check out a physician's background.

Steinberg says St. Charles will continue to scrutinize its prospective physicians regardless.

"I don't see an impact on staffing, because we will still verify the information. It will still be incumbent on each organization to verify that what [physicians] fill out is true."

There is some fear that Oregon's system will drive out credentialing services that are NCQA-certified as Credentials Verification Organizations (CVOs) and also affect some Independent Practice Associations (IPAs), which offer provider credentialing a sideline revenue stream.

Central Oregon IPA (COIPA), also based in Bend, does credential providers, but is not worried about the new system's effect.

"It's not a moneymaker for us," says John Ryan, executive director for COIPA, which represents more than 650 physicians and practitioners. "It's mainly to serve the community, since we have the infrastructure and staff."

Ryan also says Oregon's electronic system shouldn't replace outside provider credentialing organizations because outside verification makes good sense.

"I don't think it will completely remove the need… if they're doing it right," says Ryan, who also works with the Oregon Association of Medical Staff Services (OAMSS) to help steer the state toward how the mandatory system will operate.

The Oregon Health Authority (OHA), which oversees the state's public health plan as well as its children's health insurance program and employee benefits, is tasked with working out the technical details of the system.

Tom Holt, director of government affairs for Regence BlueCross BlueShield in Oregon, says there are two legislative sessions between now and the due date for Oregon's system, and while the operational minutiae are getting worked out, he expects the end result to benefit all parties who touch the credentialing process, including insurance companies like Regence.

"From our point of view, the win is simply taking the friction out of the administration of healthcare," says Holt. "Every health plan, [and every] hospital, has something that they're using. In an ideal world, there'd be one central place. For here it makes sense. We have a uniquely collaborative culture."

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

Tagged Under:


Get the latest on healthcare leadership in your inbox.