Michigan One Source Credentialing Abstract
In 2007, 27 states received Medicaid Transformation Grants under Section 6081 of the Deficit Reduction Act of 2005. The grants were rewarded to states that proposed innovative methods which in the end of the two years are designed to produce better health outcomes at lower cost.
The Center for Health Transformation is highlighting states that have received these Medicaid Transformation Grants, and will be following their progress for the next two years. In order for key decisionmakers and industry leaders from around the country to learn from others’ successes, it is our intention to provide this resource in order to showcase innovative practices from across the nation. In the future, this site will be interactive, allowing program directors to submit updates and comments regarding their program.
Project budget— $5,208,819
The advantages of One Source Credentialing include:
- A tightly integrated link between Licensing and Medicaid Provider Enrollment that will reduce the window of time that a sanctioned provider can receive inappropriate payment from months and weeks to hours or minutes.
- The wider the adoption of the One Source system in the state, the faster the information will flow to facilities – alerting them that they may have problem providers on their staffs. Allowing organizations time to take reasonable actions to address issues that they may have concerning these providers.
- The overall quality of the provider pool will improve as a whole in the state, in addition to reducing processing costs of each organization who currently processing the same information on providers repeatedly, ninety percent of which remains static in any credentialing file.
An average Michigan physician is credentialed at twelve locations at any one time (three hospitals, Medicaid, Medicare, Blues, Licensing, and five other payers or group practices) at an average cost of five hundred dollars ($500.00) per credentialing – that’s six thousand dollars ($6,000.00) per provider. There are currently 72,000 licensed professionals in Michigan most of whom work with Medicaid beneficiaries. They include nurses, physical and occupational therapist, etc. Medicaid re-credentials all providers in the system which currently numbers 40,000 or at an expense of $20,000,000. To the state government alone there are millions of dollars in labor that could be saved over time by reducing the processing of duplicated information. If this is then expanded to the other ten organizations performing the same function we eliminate significant cost from the health care system in Michigan.
The goal of the project is to implement commercially available products; use a standard front end application such as the one developed by Council for Affordable Quality Healthcare (CAQH) then integrate information technology industry standard tools such as WebCrawlers and middle ware data exchange engines to provide real-time exchange of data among stakeholder systems throughout the state. Once this technology is in place, the goal of eliminating payments to sanctioned providers within the shortest window is possible, thus eliminating fraudulent payments.
With the proliferation of high band width, low cost data lines, and regional and statewide Health Information Exchanges, these data connections become easer to make and maintain. This newly revised process will remove duplication of work, allow for administrative simplification, and reduce cost from the overall health system.
