Oregon’s Attempt to Simplify Credentialing Process Suspended

A recent opinion piece in MorningConsult.com highlights how market realities and the difficulties of building a provider credentialing solution doomed a legislatively mandated provider credentialing program.

In “Simplifying Provider Credentialing in Oregon: A Cautionary Tale for All States,” Julian Roberts describes how Oregon tried to simplify provider credentialing. A 2013 Oregon Senate bill required that the Oregon Health Authority (OHA) establish a statewide database program that would streamline access to credentialing information. The program’s goals were to reduce administrative burdens and costs by establishing a centralized data collection and eliminating duplication.

After 5 years of start-up activities, however, the Oregon program has been suspended. OHA ran into the same obstacles that other similar solutions have faced. This type of program is more complex and expensive, and takes longer to implement than projected.  

The provider credentialing process collects and verifies a health care provider’s data including education, experience, training and competency. The rigorous process ensures that health plan networks’ provider directories are up-to-date and that patients are able to choose a vetted provider for their health care.

Option: Partner with a Proven Industry Credentialing Program

Instead of trying to build a credentialing program from scratch and getting mired down in both business complexities and exacting credentialing standards, Roberts states that OHA could have partnered with an established and proven industry credentialing program.

Industry solutions are competitive and ready to go. They adhere to federal and state requirements and are cost-effective. In other words, the start-up is complete and successful, and they are now focused on simplifying the administrative burden for both providers and plans.

Article Supports State-Mandated Provider Directory Programs

Roberts asserts that another administrative component that can be better addressed by industry is state-mandated provider directories.

Even a national or centralized third-party clearinghouse or certifying entity, as one proposed solution, can be a valuable tool for consistent healthcare consumer information.

The Centers for Medicare & Medicaid Services concurs, as it recently reported that several pilot programs for creating a centralized provider data repository is encouraging. The centralized approach may result in more accurate and timely data sharing among many other benefits.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512-201-2668 or contact us via the website.