Introduction To The Texas Credentialing Verification . - Amerigroup

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Introduction to the Texas CredentialingVerification Organization (CVO) TXPEC-2417-18 February 2018

Background 84th Texas Legislative Session Senate Bill (SB) 200 (Sunset bill) passed andcontemplated a streamlined process for Medicaid provider enrollment and managedcare credentialing. HHSC agreed to allow Medicaid health plans through TAHP to manage theacquisition of the centralized credentialing entity. In December 2014 TAHP reached consensus with Medicaid health plans on acommon solution for credentialing and research began on development of bestpractice models for a common Credentialing Verification Organization (CVO). In September 2015 TAHP released the final CVO RFP and Aperture was tentativelyselected as the vendor in March 2016 with a final contract signed in June 2017.

CVO VisionSimplify the credentialing process by reducing administrativeburdens for physicians and health care providers seeking toparticipate in the Texas Medicaid program.

What is a CVO?Texas Medical Association (TMA) and Texas Medicaid MCOs proposeda statewide CVO concept to facilitate provider credentialing, which wasendorsed during the 84th Texas Legislature in SB 200. The billestablished a vision for Texas to streamline the Medicaid providercredentialing process. Texas Association of Health Plans (TAHP) andTMA have selected Aperture, LLC, for a statewide CredentialingVerification Organization (CVO) contract used by 19 Medicaid MCOs.

What is Primary Source Verification (PSV)?PSV is the verification of a provider’s reported qualifications bythe original source or an approved agent of that source.Aperture will be performing PSV functions on behalf of allMedicaid MCOs.

What is Aperture Credentialing, LLC?Aperture is the nation’s largest Credentialing VerificationOrganization providing services to some of the largest payerand provider organizations in the country. Aperture operatesnationwide and also manages several other national, statebased and specialty-based unified credentialing programs.Aperture is National Committee for Quality Assurance (NCQA)Certified and Utilization Review Accreditation Commission(URAC) Accredited for more than 10 years.

Medicaid Significance &Uniform Managed CareContract (UMCC)Requirement

CVO Importance to MedicaidThe CVO’s application process will: Save time by eliminating duplicative efforts and processes forproviders who credential and re- credential separately withmultiple MCOs. Lowers administrative costs for providers and MCOs. Utilizes existing web-based portals with CAQH and Availity toaccess practitioner credentialing application information,allowing professional providers who use those portals toeasily update and maintain their application information formultiple product lines.

Provider Contracting & EnrollmentMCO Contracting - The credentialing process is separate from thecontracting process. Providers will still need to engage with theMCO for contracting needs and provide any additional informationto complete the credentialing process.Medicaid Provider Enrollment - Providers enrolling in TexasMedicaid and CHIP through Texas Medicaid & HealthcarePartnership (TMHP) must still follow the processes as provided byTMHP/HHSC. Providers must complete the enrollment processthrough TMHP/HHSC prior to credentialing with the MCO(s).

Success in Other States Georgia: the average timeline for credentialing has beenreduced by approximately 2 months. Arizona: 80% of providers in the Alliance overlap with at leastone other plan. Initial Provider turn around time is currently at 10 days

UMCC RequirementAll Medicaid MCOs must utilize the Texas Association of HealthPlans’ (TAHP’s) contracted Credentialing VerificationOrganization (CVO) as part of its credentialing and recredentialing process regardless of membership in theTAHP. The CVO is responsible for receiving completedapplications, attestations and primary source verificationdocuments.

How the CVO Works

Process1. As done today, you will continue directly contacting the plan(s) you wish tocontract with, but you do not need to submit a credentialing application to theplan(s).2. The MCO(s) will notify Aperture, the CVO, to begin the credentialing process withyou. Aperture will reach out to providers to start the credentialing process and willalso accept the credentialing application and perform the primary sourceverification (PSV) that includes verification of your application, license and allapplicable licenses/documents.Note: Providers may still need to send some information directly to the MCO(s).

Phase One The first phase of the project will begin for some MCOs who areready to begin transitioning their new providers to the CVO inJanuary. Providers who contact the MCOs to begin the contracting andcredentialing process will begin receiving communication fromAperture Credentialing, LLC who will collect the credentialingapplication and required documentation.

Phase Two The anticipated CVO start date for all newlycredentialing providers will be April 2018. Providers who are due to be re-credentialed inSeptember will receive notification to be begin there-credentialing process in April.

CAQH & AvailityThe Council for Affordable Quality Healthcare (CAQH) willremain available for practitioners and health professionalswho currently use it and a new solution will be offered forancillaries and facilities through Availity beginning April2018. Paper applications will continue to be accepted byAperture.

Frequently Asked Questions

Which Providers Will be CredentialedThrough the CVO?All Medicaid provider types will be credentialed through the CVOexcluding DMOs and providers who are currently credentialedthrough a delegation. An example of this includes the majority ofpharmacy providers who are credentialed through their PharmacyBenefit Managers (PBM). Pharmacies who provide a medicalservice such as DME will continue to be credentialed by their MCOand will participate in the CVO.Any new provider who is not contracted with an MCO will continue tofollow the current process in place for contracting and credentialing.

What will Change for me in the CredentialingProcess?For the initial phase of the roll-out beginning in January for someMCOs, the only change a provider should expect is to beginreceiving communications from Aperture regarding the credentialingapplication and PSV functions.More information on the single re-credentialing date and process willbe shared in the coming months.

Does the streamlined credentialing processapply to commercial insurers?Commercial MCOs are not required to use the CVO,however the goal is to expand the usage of the CVO tothese MCOs.

a statewide CVO concept to facilitate provider credentialing, which was endorsed during the 84th Texas Legislature in SB 200. The bill established a vision for Texas to streamline the Medicaid provider credentialing process. Texas Association of Health Plans (TAHP) and TMA have selected Aperture, LLC, for a statewide Credentialing

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