Welcome to the 12th Annual

HealthLine Systems™ Client Strategy Conference

October 24-25, 2001Hyatt Regency

Chicago, IL

Today’s Objectives• Demonstrate time-savers to help the

“understaffed” office meet objectives with current staff

• Identify new ways to use MSLW/Echo to reduce costs

• Explore changes in technology & regulatory requirements

• Identify & share “best practices”

The Actions

• Four in-depth, practical sessions

• Three relevant case studies

• Networking opportunities

• Review of the OIG program

• HealthLine Systems’ future plans

Credentialing Past & Present

• Fundamentals of credentialing remains unchanged from the typewriter & file cabinet days:~ Verify everything~ Verify as quickly as possible~ Grant privileges specific to the providers

education and training

• So what does the future hold?

The Challenge for MSSP’s

Lack of staff

Background checks

Retention of files Allied Health

Privileges - Core, Temp’s, Lists

Locum Tenens

JCAHO, NCQA, URAC

Technology

HIPAA

Do More with Less

• Credentialing is a labor & materials intensive process. For example:

• $463.00 to process a new applicant~ Administrative overhead -- $103.00~ Staff time -- $322.00~ Verification costs $38.00

• Staff time & overhead = 90%

Electronic Credentialing

• More electronic sources now available - over 50 internet sources

• Online applications slowly gaining acceptance

• Scanned copies eliminates paper

More Requests for Information

• More organizations requesting ‘detailed’ information

• Dissemination of ‘real-time’ clinical privileges

• Internet based ‘auto-verify’• Intranet based R & R’s, bylaws, calendars• Online status checks

Economies of Scale

• “Standardized” state-wide applications

(4 mandatory, dozens voluntary)• VetPro - the VA data bank• CAQH common database• Centralized credentialing, particularly for

health system with MCO’s

According to the Crystal Ball

• 2005 - 100% electronic credentialing

• QA data electronically shared

• Federal data sources provide immediate reports

• PDA’s used to view information