Six Large California Health Plans Launch Online Program to Share Results of Medical Group Audits

Six large California health plans have launched a Web-based program that allows them to share results from audits of physician credentialing standards at medical groups with which they contract. According to the health plans, the Credentialing Oversight program, sponsored by the Pacific Business Group on Health and the National Committee on Quality Assurance, will help eliminate unnecessary audits and reduce the amount of time and money that health plans and medical groups spend on the audit process. Under the program, the health plans use an online questionnaire to evaluate the credentialing standards and processes that medical groups use to evaluate physicians in a number of areas, such as training, board certification, malpractice history and loss of license or hospital admitting privileges. The program meets both Medicare and private credentialing standards. The health plans post the results of the audits on the Web site of the Industry Collaborative Effort, a coalition of health insurers, providers, employers and regulatory agencies. Health plans can access the results to avoid repeat audits in cases where they contract with the same medical group. PacifiCare of California, one of the six plans in the program, posted the first audit online on March 4 and plans to post audits of 50 additional medical groups over the next two months. Two additional participants, Aetna Inc. and Blue Shield of California, plan to post audits soon. The other three participants, Blue Cross of California, Cigna Corp. and HealthNet of California, will begin to share their audits this fall. CMS, the Department of Health Services and the Department of Managed Health Care also have agreed to participate in the program (Pacific Business Group on Health release, 4/8).