AmeriHealth Caritas Credentialing

1. AmeriHealth Caritas Credentialing AmeriHealth Caritas PA AmeriHealth NORTHEAST Keystone First • Joanne Dugan, • Director of Credentialing

2. Industry Trends • Paperless credentialing process • Manual to automated functionality • Ongoing monitoring

3. Paperless Credentialing Process • AmeriHealth Caritas worked with CACTUS and developed an automated custom program to attach the CAQH data to each providers’ individual profile • Provider data is in one place • Reduction in postage and paper • 25% reduction in termination for non compliance

4. Manual to Automated Functionality CAQH Management Module - auto populates CAQH data into the providers’ individual profile in CACTUSABMS Direct Connect – checks for board expiration, updates are provided through CACTUS Delegate Importer – auto populates delegate data into CASTUS from an EXCEL spreadsheet

5. Ongoing Monitoring • Monitoring practitioners’ state licensure sanctions and limitations between credentialing events: • Automated License Expiration Monitoring Module/DEA Module – web crawler alerts coordinator when issue arises – includes repeated notices before and after expiration date and also updates new information when provided • NPDB Continuous Query – automatic notification via email of any changes in a provider’s report for status • OIG Monthly Sweep – conducted through CACTUS • Quality Monitoring – Quality department notifies Credentialing of any quality of care issues • PA State Disciplinary Report – received monthly and imported directly into CACTUS • Preclusion Letters – upon notification from Regulatory Affairs, the letter is scanned directly into the Provider’ file

6. Thank you for your attention! Questions! You can email me at: jdugan@amerihealthcaritas.com