Working to Streamline Red Tape for Providers & Increase Access to Care for Texans in Medicaid
FOR IMMEDIATE RELEASE
September 1, 2015
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AUSTIN—The Texas Association of Health Plans (TAHP) has issued a Request for Proposals (RFP) for the development, implementation, and management of a Texas Statewide Consolidated Credentialing Verification Organization (CVO) for Medicaid health plans. The CVO is intended to simplify the administrative process for providers seeking to deliver quality care to Texans enrolled in a Medicaid health plan.
“The managed care approach in Texas—where private health plans contract with the state to manage Medicaid—has been a national leader in using innovation to achieve billions in savings for taxpayers, increase access to quality care, and enhance the lives of millions of Texans enrolled in the program. Now, the private health plans that have led those efforts are coming together and collaborating on a first-of-its-kind project in Texas to make it easier for providers to participate in Medicaid and deliver care to Texans who need it most.
“This common-sense approach is aimed at saving physicians time, reducing their paperwork and streamlining the administrative process for joining health plan networks. TAHP looks forward to making progress on these important goals and continuing to work with our member plans on additional solutions to enhance the experience of Medicaid providers and increase efficiency in the health care industry.”
The CVO project is an initial component of a vision by Medicaid health plans to foster collaboration between plans to improve the provider experience in Medicaid. The goal is to facilitate collaboration in the health plan community to standardize and simplify where it makes sense, while continuing to foster the private market innovation and flexibility that has allowed health plans to save taxpayers billions and improve the lives of Texans being served by Medicaid.
What is Credentialing?
Credentialing is the process health plans use to verify and evaluate a health care provider’s qualifications and practice history before allowing the provider to join the plan’s network of providers. Credentialing allows health plans to ensure that their members have access to safe, high-quality health care providers. It also allows plans to make sure their networks have the types of providers their members need. Today, health care providers must submit their information separately to each health plan in whose network they would like to participate. Under the solution TAHP is seeking, Medicaid health plans would use a single, statewide CVO, reducing the number of times providers would need to submit their information.
The concept for a statewide CVO emerged from discussions that began in 2014 between TAHP and Medicaid health plans aimed at streamlining the administrative process for providers joining health plan networks. In April 2015, TAHP released a Request for Information (RFI) to obtain credentialing industry input on a solution. The RFI was broadly circulated to elicit comments not only from the credentialing verification organization (CVO) industry, but from the health care community as well. RFI respondents were invited to Austin to participate in a series of demonstrations and discussions in June 2015 and the information acquired through the RFI was used to develop the final RFP, which was issued September 1, 2015.
- The RFP will acquire the services of a firm that will develop, implement, deploy and manage a statewide managed care CVO.
- Vendors will be required to submit proposals to TAHP by October 2, 2015.
- Proposals will be evaluated by teams from TAHP member plans.
- entative contract award is projected for October 23, 2015.
The Texas Association of Health Plans
The Texas Association of Health Plans (TAHP) is the statewide trade association representing private health insurers, health maintenance organizations, and other related health care entities operating in Texas. Our members provide health and supplemental benefits to Texans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. TAHP advocates for public and private health care solutions that improve the affordability, access and accountability of health care for many Texans. As the voice for health plans in Texas, TAHP strives to increase public awareness about our members’ services, health care delivery benefits and contributions to communities across Texas.