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Frequently Asked Questions
  • What is the Oregon Common Credentialing Program?
  • Which credentialing organizations are required to use the common credentialing solution?
  • Will the program include primary source verification of health practitioner information?
  • Are there assurances for credentialing organizations relying on accuracy of practitioner information?
  • Will the program include the process of privileging?
  • How do health care practitioners submit credentialing information to the program?
  • What health care practitioner information will be collected in the common credentialing solution?
  • May credentialing organizations request credentialing information directly from health care practitioners?
  • Who decides if a health practitioner will be credentialed?
  • Will there be a fees associated with the Oregon Common Credentialing Program?
  • When will credentialing organizations be required to participate in the Common Credentialing program?
  • Which health care practitioners are required to use the common credentialing solution?
  • When are health care practitioners required to use the common credentialing solution?
  • How will health care practitioners submit credentialing information to the common credentialing solution database?
  • Will health care practitioners be required to periodically update credentialing information in the common credentialing solution database?
  • Do health care practitioners have to submit credentialing information to credentialing organizations?
  • Will health care practitioner credentialing information be publicly disclosed?
 

What is the Oregon Common Credentialing Program?

In July 2013, the Oregon State Legislature passed Senate Bill (SB) 604 that requires the Oregon Health Authority (OHA) to establish a mandated program and database to provide credentialing organizations access to information necessary to credential or re-credential all health care practitioners in the state. Health care practitioners are currently credentialed independently by credentialing organizations, resulting in a duplication of efforts and an administratively burdensome process for all stakeholders. Under SB 604, health care practitioners or their designees will submit necessary credentialing information into a common credentialing solution database one time and credentialing organizations will be required to use the solution to obtain that information. This program will streamline the process of applying for and maintaining credentials for practitioners. 
 
The Common Credentialing Advisory Group  was established in September 2013 that consists of individuals representing credentialing organizations, health care practitioners and health care regulatory boards (HCRBs), including representatives from large health care entities. This group advises OHA on the implementation of SB 604. In July 2015, the Oregon State Legislature passed SB 594 allowing OHA to identify an operational date via rule provided OHA notifies participants at least six months in advance. OHA expects early adopters to be on board in 2018 with the program becoming fully operational shortly after.

 
The OCCP will include:
  • A centralized web-based electronic solution that will collect, store, and maintain practitioner credentialing information
  • A process for collecting and verifying credentialing information
  • A process for practitioners or designees to access the Solution to submit information with 120 day attestations
  • A process for credentialing organizations to input, access, and retrieve practitioner credentialing information
  • A process for Health Care Regulatory Boards to input and access practitioner credentialing information
  • Fee collection for mandated users
The Program will NOT include:
  • The decision to credential a practitioner
  • The process of privileging a practitioner
 
The OCCP will be administered under Oregon Administrative Rules 409-045-0025 through -0075.

Which credentialing organizations are required to use the common credentialing solution?

All organizations meeting the definition of credentialing organization (CO) in SB 604 are required to participate in the program. It is defined as a hospital or other health care facility, physician organization or other health care provider organization, coordinated care organization, business organization, insurer or other organization that credentials health care practitioners. 

Oregon Administrative Rule (OAR) 409-045-0025(7) defines “credentialing organization” according to the legislative language, but adds a list of entities identified based on legislative intent. This includes, but is not limited to the following: Ambulatory Surgical Centers, Coordinated Care Organizations, Dental Plan Issuers, Health Plan Issuers, Hospitals and Health Systems, and Independent Physician Associations.

While this definition is clear to the listed entities, it is less clear in defining what other health care facilities or business organizations exist that credential health care practitioners. The following questions are to be used to guide organizations in making the distinction of whether or not they are considered a credentialing organization. An organization shall be considered a credentialing organization if it answers “yes’ to one or more of the following questions:

Does the organization recognize that it credentials licensed independent practitioners?
Does the organization have a credentialing committee?
Does the organization have governing requirements or rules (including state law and accrediting entity requirements) that specifically require any practitioners to be “credentialed?”

A provider practice would not be considered a credentialing organization as their practitioners are credentialed by other “credentialing” organizations as independent practitioners in order to receive payment for services they provide through the practice. In addition, facilities such as health homes would not be considered credentialing organizations as any practitioner that visits the facility is simply checked for licensure and not fully credentialed according to any standards.

Will the program include primary source verification for health care practitioners information?

Yes, health practitioner information will be primary source verified by the OCCP vendor according to state, national, and accrediting entity standards (e.g., Joint Commission, National Committee for Quality Assurance, Utilization Review Accreditation Committee, and DNV Healthcare). Peer references will not be verified by the OCCP since the interpretation of references can vary by organization.

Are there assurances for credentialing organizations relying on the accuracy of practicioner information?

Yes. SB 604 maintains that a credentialing organization that, in good faith, uses credentialing information provided under this Program is immune from civil liability that might otherwise be incurred or imposed with respect to the use of that credentialing information. Apart from this safe harbor, the Program will be using state and national standards, primarily based on accrediting entity standards for the credentialing process. Verifications with be frequently audited to ensure accuracy.

Will the program include the process of privileging?

No. Privileging is not included under the common credentialing program.  As such, verifications related to privileging will not be conducted under the Program. Health organizations will determine a health care practitioner’s specific scope and content of patient care services.

How will health care practitioners submit credentialing information to the program?

Health care practitioners or their designees will submit necessary credentialing information into the program via a web portal. The information collected in the Common Credentialing Solution is driven by the standardized Oregon Practitioner Credentialing Application. Credentialing information will then be verified and maintained by the OCCP vendor according to state, national, and accrediting entity standards, (e.g., National Committee for Quality Assurance, Joint Commission, Utilization Review Accreditation Committee, and DNV Healthcare). Every 120 days, health care practitioners or their designees must attest to the credentialing information in the database. 

What health care practitioner information will be collected in the common credentialing solution? 

The information collected in the OCCP will be the data elements currently collected via the standardized Oregon Practitioner Credentialing Application and verified according to national accrediting entity and Medicare/Medicaid standards. 

May credentialing organizations request credentialing information from health care practitioners?

Credentialing organizations are prohibited from requesting information from health care practitioners that is available in the common credentialing solution database.  If the organization requires supplemental information, such as an additional peer reference, this information may be requested directly from the health care practitioner.

Who decides if a health practitioner will be credentialed?

The credentialing organization makes this decision.  The Program provides access to verified practitioner information, but the decision to credential a practitioner is outside the scope of the program.

Will there be fees associated with the Oregon Common Credentialing Program?

Yes, there will be fees for both credentialing organizations and health care practitioners as SB 604 call for OHA to be able to charge fees to these mandated users to support the cost of administering the program. While the exact cost has not yet been determined, OHA and its stakeholders have agreed to a preferred fee structure that will include:
  • A one-time application fee for health care practitioners
  • A one-time set up fee for credentialing organizations
  • Annual subscription fees for credentialing organizations
OHA acknowledges that credentialing organizations differ in their resources and the benefits gained from a common credentialing program. These factors will be considered when finalizing the fee structure. Once decided on, fees will be codified in rule.

When will credentialing organizations be required to participate in the Common Credentialing program?

OHA expects early adopters to be on board in 2018 with the program becoming fully operational shortly after.

Which health care practitioners are required to use the common credentialing solution?

All health practitioners meeting the definitions in SB 604 and Oregon Administrative Rule 409-045-0025 are required to participate in the OCCP. Health care practitioner is defined as an individual authorized to practice a profession related to the provision of health care services in Oregon for which the individual must be credentialed. This includes, but is not limited to the following: Acupuncturists, Audiologists, Certified Registered Nurse Anesthetist, Chiropractor, Clinical, Nurse Specialist, Doctor of Dental Medicine, Doctor of Dental Surgery, Doctor of Medicine, Doctor of Osteopathy, Doctor of Podiatric Medicine, Licensed Clinical Social Worker, Licensed Dieticians, Licensed Marriage and Family Therapists, Licensed Massage Therapists, Licensed Professional Counselor, Naturopathic Physician, Nurse Practitioner, Occupational Therapists, Optometrist, Oral and Maxillofacial Surgeons, Psychologists, Physical Therapists, Physician Assistants, Psychologist Associate, Registered Nurse First Assistant, and Speech Therapists.

When are health care practitioners required to use the common credentialing solution?

OHA expects early adopters to be on board in 2018 with the program becoming fully operational shortly after.
 However, the OHA may ask practitioners to volunteer to submit their information earlier in preparation for the required date. Practitioners will be notified of opportunities for early submission at a later date.

How will health care practitioners submit credentialing information to the common credentialing solution database?

Once the OCCP is operational in 2018, health care practitioners or their designees will be required to submit credentialing information via a web-based solution.  Practitioner credentialing information will be saved in the Common Credentialing solution and provided to credentialing organizations for which the practitioner has identified is able to receive it.

Will health care practitioners be required to periodically update credentialing information in the common credentialing solution database?

Yes. Every 120 days, health care practitioners or their designees must attest to the credentialing information in the database.  Although practitioners must attest more frequently than the current process requires, attestations will only need to be done through the centralized credentialing solution rather than to multiple credentialing organizations. This will ensure information is true and current any time a credentialing organization accesses a practitioner’s record for credentialing purposes.

Do health care practitioners have to submit credentialing information to credentialing organizations?

No. Credentialing organizations must use the database to access practitioner credentialing information. Practitioners must identify in the solution, which credentialing organizations are allowed access to their credentialing record. Organizations may only ask practitioners for information that is not available through the solution. This will minimize credentialing organization requests and attestations, improving the process for both credentialing organizations and practitioners.

Will health care practitioner credentialing information be publicly disclosed?

Privacy is a priority. Health care practitioner credentialing information, other than general information used for provider directories, will not to be publicly disclosed. Nor will it be used for marketing purposes.
 
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