Physician Leaders Share Ideas for Improving Credentialing Process in MA Program

Members of PAMED staff joined physician leaders at a meeting on Sept. 11 with Secretary of Human Services Ted Dallas.

The Pennsylvania Medical Society (PAMED), Philadelphia County Medical Society, and leaders from large physician groups across the commonwealth met in Philadelphia on Friday, Sept. 11, with Secretary of Human Services Ted Dallas.

The group discussed expanding access to care by improving the process used to credential physicians for participation in the Medical Assistance program. Participants shared insights for how to make the process better and allow providers to be more easily and timely credentialed by the state.

Sec. Dallas was very receptive to the concerns of the group and the Department of Human Services and PAMED will convene a follow-up meeting focused on implementing change in the next few weeks.

Members tell PAMED that the credentialing process simply takes too long. More than 50 percent of respondents in a 2014 survey conducted by PAMED said the process took 90 days or longer to credential new physicians. This delays physicians from seeing patients.

Legislation to streamline the credentialing process and make it uniform across all insurers is expected to be introduced early this fall, and PAMED strongly supports this.

“It causes a problem with respect to direct patient care in that you have physicians, especially those that are graduating residency programs that want to get in to see patients,” said David Thompson, PAMED’s director of legislative affairs. “They move into the state from wherever they trained and they join a practice or a hospital system and they have to wait until they are credentialed by the insurer before they can see a patient [after they are already licensed by the state board, and many times, also credentialed by a hospital or health system].”

As part of the legislation, PAMED is also advocating that, after the insurer has had a physician’s credentialing application for a certain amount of time, and no decision has been made, the physician be provisionally credentialed so that they can start seeing patients. Once they are formally credentialed, the insurer could then begin to pay the physician retroactively for care they provided during the time they were provisionally credentialed.