Not playing by the rules
Credentialing has always been a major headache, labor intensive and many times a nightmare for physicians and their staff.
With this in mind, the ISMA finally succeeded in creating a 2005 law to simplify the credentialing process for Indiana physicians. Before passage of Senate Enrolled Act 43, insurers and HMOs used a variety of credentialing application forms and it created a lot of work and expense for offices.
Using one standard application form would dramatically simplify the process and the 2005 law directed the Indiana Department of Insurance to develop and implement the form. The form was finally developed by the Council for Affordable Quality Healthcare (CAQH) and referred to as the Universal Provider Datasource (UPD). CAQH is a nonprofit alliance of health plans and trade associations that serves as a catalyst for industry collaboration on initiatives to simplify administration for health plans and providers – with the ultimate goal of improving the health care experience.
The passage of the three-year old law requires insurers and HMOs doing business in Indiana to accept the CAQH form and it allows physicians to enter information just once to satisfy application requirements. The individual Insurers and HMOs may choose to accept the document submitted electronically, meaning you complete the form online, or they may require you to print it and mail it to them.
All of this sounds great and it would simplify the process, but as expected, the Insurers and HMO’s don’t play by the rules. The ISMA has been alerted that various insurers are now attaching amendments to the CAQH form and requiring physicians to complete the additional documents before they can be credentialed. This is no different than what the bill was supposed to fix.
The ISMA continues to work with insurers to resolve this matter because it is contrary to the intent of the 2005 law. That likely will not be successful and there will have to be more time and energy spent enacting new legislation to prevent these ongoing hassles from the Insurance companies and HMO’s.
There are the following sites for Frequently Asked Questions here and access to the CAQH form on the ISMA Web site here.
With this in mind, the ISMA finally succeeded in creating a 2005 law to simplify the credentialing process for Indiana physicians. Before passage of Senate Enrolled Act 43, insurers and HMOs used a variety of credentialing application forms and it created a lot of work and expense for offices.
Using one standard application form would dramatically simplify the process and the 2005 law directed the Indiana Department of Insurance to develop and implement the form. The form was finally developed by the Council for Affordable Quality Healthcare (CAQH) and referred to as the Universal Provider Datasource (UPD). CAQH is a nonprofit alliance of health plans and trade associations that serves as a catalyst for industry collaboration on initiatives to simplify administration for health plans and providers – with the ultimate goal of improving the health care experience.
The passage of the three-year old law requires insurers and HMOs doing business in Indiana to accept the CAQH form and it allows physicians to enter information just once to satisfy application requirements. The individual Insurers and HMOs may choose to accept the document submitted electronically, meaning you complete the form online, or they may require you to print it and mail it to them.
All of this sounds great and it would simplify the process, but as expected, the Insurers and HMO’s don’t play by the rules. The ISMA has been alerted that various insurers are now attaching amendments to the CAQH form and requiring physicians to complete the additional documents before they can be credentialed. This is no different than what the bill was supposed to fix.
The ISMA continues to work with insurers to resolve this matter because it is contrary to the intent of the 2005 law. That likely will not be successful and there will have to be more time and energy spent enacting new legislation to prevent these ongoing hassles from the Insurance companies and HMO’s.
There are the following sites for Frequently Asked Questions here and access to the CAQH form on the ISMA Web site here.
Labels: HMO's, insurance, legislation
posted by Anonymous at 6:04 AM
1 Comments:
SUBMIT FOXNEWS.COM HOME > HEALTH
Obesity 'Virus' Spreads Like Common Cold, Scientists Say
Monday, January 26, 2009
Obesity can be "caught" as easily as a common cold from other people's coughs, sneezes and dirty hands, scientists said Monday.
The condition has been linked to a highly-infectious virus which causes sniffles and sore throats.
Nikhil Dhurandhar, an associate professor at The Pennington Biomedical Research Center, in Baton Rouge, La., said the virus, known as AD-36, infects the lungs then whisks around the body, forcing fat cells to multiply and also causing sore throats.
"When this virus goes to fat tissue it replicates, making more copies of itself and in the process increases the number of new fat cells, which may explain why the fat tissue expands and why people get fat when they are infected with this virus," Dhurandhar said.
In one test, a third of obese people had the rare and highly contagious virus compared to just 11 percent of thinner people. Weight gain can last three months until the body has built up resistance to the bug.
New research supports earlier theories from studies on weight gain; evidence in tests on mice and chickens shows the bug could cause overweight people to gain weight.
"People could be fat for reasons other than viral infections, so it’s pointless for fat people to try to avoid infection," said Dhurandhar.
The study also reveals research claiming dieters always feel hungry because humans have a "natural body weight" and they will always suffer hunger pangs.
The Pennington Biomedical Research Center, a campus of the Louisiana State University system, conducts both clinical and basic research. Its mission is to promote healthier lives through research and education in nutrition and preventive medicine.
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