Table of Contents

iExchange™: Electronic Innovation
Health Insurance Portability and Accountability Act
Recent Literature on: Cancer, Diabetes, Congestive Heart Failure, Coronary Artery Disease and Asthma
CareFirst Offers Oncology Patients Access to Quality Care
CareFirst's Proposed Merger With WellPoint Health Networks
Recognizing and Overcoming Inadequate Health Literacy: a Barrier to Care
2002 MHCC HMO Report Cards Released
Magellan Behavioral Health: Postpartum Depression Program
Council for Affordable Quality Healthcare: Credentialing

iExchange™: Electronic Innovation

What Is iExchange™?
iExchange™ is a free Internet service that gives hospitals a single access point to exchange care management data and certification status with CareFirst BlueCross BlueShield (CareFirst), while reducing transaction turnaround time and administrative costs. MEDecision is an independent company that provides this innovative resource to CareFirst.

This facility-based resource requires less effort, ensures a predictable experience and simplifies the authorization process. With this service, hospitals can directly submit authorization transactions to CareFirst plans and receive immediate feedback on whether the transaction meets the business and clinical requirements necessary for approval. If the transaction requires a CareFirst associates's involvement, the case will pend so it can be routed to the appropriate department for proper handling. Hospitals can also access patient eligibility and inquire about a transaction's status post-submission.

By employing iExchange™, facilities have the ability to streamline their submission process by listing the top 10 ICD-9 codes and procedure codes they utilize and choose the correct codes from their lists when submitting a transaction.

iExchange™ supports Health Insurance Portability and Accountability Act (HIPAA) compliance (see HIPAA-related article) with:

• the ability to block transactions through the Internet based on patient request
• support for digital certificates
• 128-bit encryption
• audit trails
• password protection
• unique identifiers
• code sets

GBMC's Implementation of iExchange™

CareFirst recently piloted iExchange™ at the Greater Baltimore Medical Center (GBMC).

GBMC was rated Central Maryland's "Busiest Surgical Hospital" every year from 1995-200, which indicates that GBMC was chosen by more patients and doctors for surgery than other hospitals during that period. With 302 licensed beds and 1,417 physicians, the hospital is a perfect fit for iExchange™.

GBMC's implementation and utilization of iExchange™ illustrates GBMC's dedication to enhance quality of service and promote excellence.

"iExchange™ has saved my staff time when verifying patient eligibility and getting claims authorized," said GBMC's Director of Patient Financial Services Kathy Anderson. "They no longer have to fax inquiries, wait and then follow up on them. As a result, these issues are resolved in a more timely manner."

CareFirst provides training sessions for designated users of this valuable new service.

Sign up for this service is voluntary. For more information, contact your Provider Service Representative.

Health Insurance Portability and Accountability Act

The Department of Health and Human Services issued the final modifications to the Health Insurance Portability and Accountability Act (HIPAA) Privacy regulations on August 14, 2002. The modifications, which were issued eight months before the privacy compliance deadline of April 14, 2003, provide stronger privacy protection for patients without hindering the quality of health care. The complete regulation can be viewed by visiting the Office for Civil Rights Web site.

The Privacy Rule states that patients will have increased access to their medical records and other information used to make decisions about their care. They will also be able to request information regarding where providers have sent their personal information for nonroutine purposes. When you provide information for treatment, payment and health care operations, you will not need to track the disclosures.

The Privacy Rule applies to covered entities - health care providers who transmit protected health information relating to covered transactions in an electronic format, as well as health care plans and clearinghouses. As a provider (and likely a covered entity), the Privacy Rule impacts how you handle your patients' protected health information and requires that you give your patients written notice of your privacy practices and their privacy rights. The Privacy Rule applies to information that is maintained electronically, orally or on paper.

Virtually all health care providers and businesses already have existing processes in place to protect patients' privacy. All covered entities have to comply with the Privacy Rule. The Privacy Rule contains a "reasonableness standard" that permits each entity to develop policies and procedures that fit with their work environment, allowing for the covered entity to determine the most appropriate approach they will use to safeguard protected health information.

Protecting the health information of individuals is important to us all. Both member and provider contracts allow CareFirst to obtain medical records and treatment information, and to use that information to assist CareFirst in member education and administration of member contract benefits. Therefore, under HIPAA, CareFirst representatives may continue to contact physicians and facilities to request this type of information for these purposes.

Under the HIPAA Privacy Regulations, health plans and health care providers do not need individual authorization to provide protected health information to a business partner for treatment, payment or health care operations. And so, requesting this information is not a violation of the final HIPAA Privacy Rule, but rather a way to ensure timely treatment for members and payment to institutional and professional providers rendering the services. Below are a few examples that may help to clarify the point.

• A Quality Improvement Nurse contacts a participating physician requesting member information during a review of chart for Health Plan Employer Data and Information Set (HEDIS) studies. The requested information is considered health care operations and should be provided. The state of Maryland also requires all health plans to report this information.
• A Case Manager contacts a participating physician for a member who is requesting Case Management services. The requested information is necessary to complete the careplan (considered health care operations) for the member and should be provided.
• A Utilization Review Nurse needs to review all clinical information to approve an inpatient hospital stay for payment. The information (considered health care operations) should be provided, and if not, may delay payment to the facility.

In addressing this issue, we hope to clarify any questions that may arise with respect to the HIPAA Privacy Regulation and contract requirements related to CareFirst's request for member information. Your cooperation is appreciated as we continue to work together for the health of our members. Additional questions or concerns can be answered by contacting your Provider Relations representative.

Recent Literature on: Cancer, Diabetes, Congestive Heart Failure, Coronary Artery Disease and Asthma

Cancer

Diabetes

Congestive Heart Failure

Coronary Artery Disease

Congestive Heart Failure

CareFirst Offers Oncology Patients Access to Quality Care

As one of the region's top health insurers, CareFirst has an opportunity to predict and plan for changes in care given to members. In the area of cancer care and treatment, some new research can completely change the way certain patients are treated.

A recent case is the new drug STI571 (imitinib mesylate), which has improved both the management of and complete response rate for some patients with chronic myelogenous leukemia (CML).

Some diseases benefit from new use of older medicines. CareFirst anticipates these changes and assures that the delivery system is managed to deliver the new regimens. The patients then get the best treatment at the best time in the most appropriate setting.

For example, in May 2002, the annual meeting of the American Society of Clinical Oncology (ASCO) highlighted research on the treatment of colon cancer. Outcomes for 795 patients with advanced colorectal cancer were studied by a consortium of large cooperative cancer researchers, including the Southwest Oncology Group, Eastern Cooperative Oncology Group, and the Cancer and Leukemia Group B. One finding in the preliminary report was that a new drug, oxaliplatin, is effective.

"Another take home message from this study, in my opinion, is the enforcement of the infusion 5-fluorouracil (5-FU) approach," said Dr. Leonard Saltz, the named researcher of the Saltz Regimen, formerly the standard chemotherapy for advanced colorectal cancer. "Although these data don't compel us to use oxaliplatin first line, they give us the option. The data also indicate that regardless of the second drug we use, we should use the 5-flourouracil as a continuous 48-hour IV infusion, instead of the short injections American oncologists have used."

We at CareFirst observed these developments and assessed our readiness. In a check of our data, we observed that of 600,000 members, few cancer patients were being treated with the 48-hour 5-FU infusion either at home or in an inpatient setting. Some may have been getting extended 5-FU infusions from the medical oncologist office, but that did not appear to be the norm.

Would our home care delivery system be ready if, for the patient's benefit, these 48-hour 5-FU infusions were used more frequently?

CareFirst did an assessment of our largest infusion provider, Neighborcare. Neighborcare has 24-hour coverage, frequent delivery ability, (until 2:30 a.m., if necessary) and coverage of almost all the CareFirst area.

Each cancer patient has an assigned team that would meet weekly to make sure the patient's care is proceeding well. Each team includes a pharmacist and nurse for each patient. In addition, the manager in charge of homecare is an experienced cancer nurse.

CareFirst is excited when research uncovers better ways to treat patients. We have a high-quality alternative to hospitalization for most patients needing 48-hour 5-flourouracil. We expect some oncologists to develop other outpatient strategies, but CareFirst is ready to assist and facilitate the best outcomes for our members with advanced colorectal cancer.

CareFirst's Proposed Merger With WellPoint Health Networks

One question being asked by regulators in Delaware, Maryland and Washington, D.C. as they examine the proposed merger of CareFirst and WellPoint Health Networks is - why WellPoint?

CareFirst's management and board of directors conducted a thorough, deliberate process before reaching a definitive agreement in November 2001 to be acquired by WellPoint Health Networks (WellPoint). In the months leading to the agreement, CareFirst narrowed its potential partners to WellPoint and Trigon - a Virginia-based for-profit Blues plan (Trigon has since been acquired by Anthem, Inc). CareFirst's decision was based on finding the partner with the best "fit" - philosophically, strategically and financially.

Philosophy
Understanding the philosophy of a potential partner was critical in CareFirst's selection process. Through discussions with WellPoint, it became clear that the company shared CareFirst's philosophy of concern for its employees, a commitment to local corporate citizenship and an understanding of the need for local decision-making on health care issues. As WellPoint CEO Leonard D. Schaeffer made clear in testimony filed with the Maryland Insurance Commissioner, it's the local health plan that has "…established long-term relationships with the hospitals, physicians and other professionals…with a vested interest in the health of the local population." WellPoint also has a history of establishing local physician advisory committees to maintain and strengthen the connection between local providers and the company. The company's commitment to preserving CareFirst's local operations means that providers would continue to work with the local CareFirst staff that they work with today.

Strategy
Business strategy and success is also a major factor in selecting a partner. To ensure a smooth transition for providers, members and customers, CareFirst sought a partner with a track record of successfully bringing together companies. WellPoint has done just that with Blues plans in Missouri and Georgia. In addition, WellPoint offered an organizational structure that made sense - one that called for continued local leadership and establishment in Maryland of a new Southeast regional headquarters for WellPoint.

Finances
CareFirst worked diligently to find a partner capable of offering a fair price for CareFirst. In the end, WellPoint and Trigon both offered $1.3 billion for the company - a price that was in keeping with independent evaluations done for CareFirst. Just as importantly, CareFirst wanted a partner with the financial resources necessary to make investments in technology, products and services that will allow us to more efficiently work with providers and serve our members better. With more than 12 million members and $12.4 billion in revenue, WellPoint has the stability and strength necessary to make necessary investments in CareFirst's future.

These factors and others made it clear that WellPoint was the best "fit" and the best partner to help CareFirst carry forward the Blue tradition in Delaware, Maryland and DC.

Recognizing and Overcoming Inadequate Health Literacy: a Barrier to Care

Reprinted from the May 2002 edition of the Cleveland Clinic Journal of Medicine
By Mark V. Williams, M.D., Director, Hospital Medicine Unit, Emory University School of Medicine, Atlanta

"[The] new civil right in today's society is literacy…Imagine that in the greatest, wealthiest nation in the world, seven out of 10 fourth-graders in big cities and rural areas cannot read…It is our greatest failure as a nation. It is our failure as a people." -Rod Paige, Secretary, U.S. Department of Education

A shocking number of patients cannot participate effectively in their own care for the simple reason that they cannot read adequately.

Compounding the problem, we physicians speak a specialized language ("medicalese") that is often unintelligible to outsiders. Moreover, many patients are expert at concealing their poor literacy skills.

Inadequate health literacy has measurable ill effects on health. Given the increasing complexity of health care, which requires increased involvement of patients, we need to address this common but underappreciated problem and find ways to communicate with patients more effectively.

Good Communication is Vital

Good communication between physician and patient is a cornerstone of good health care.
Yet, many patients have difficulty understanding their doctors' instructions. Even immediately after leaving the physician's office or the hospital, patients may recall no more than 50% of the important information just given to them.

Furthermore, communication between physician and patient is becoming more difficult as health care becomes more complex. For example, 30 years ago there were only about 650 prescription drugs, and the average hospital stay for acute myocardial infarction was four to six weeks; today there more than 10,000 prescription drugs, and a hospital stay for acute myocardial infarction is typically two to four days.

In addition, with the increasing prevalence of chronic conditions such as diabetes, high blood pressure and congestive heart failure, patients are required to know how to manage their own health care outside the clinic and hospital.

One-Fourth of Americans are Functionally Illiterate

In 1991, Congress defined literacy as "an individual's ability to read, write and speak in English, and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one's goals, and develop one's knowledge and potential."1

By this definition, millions of people living in the United States are functionally illiterate.
According to the National Adult Literacy Survey (NALS), roughly one fourth of adults in the United States may lack the necessary skills to function adequately in modern society.2 These people come from all types of backgrounds; however, functionally illiterate adults are more likely to be older, poorer, less educated and have more health problems.

Health literacy is even lower

An individual's health literacy-- "the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions"-- may be significantly worse than his or her general literacy, because functional literacy is context-specific.

The language of medicine is highly technical, and outsiders may not understand it. Gibbs et al.3 reported a large variation among patients in their ability to comprehend commonly used medical terms: only 13% of the 125 participating patients understood the meaning of "terminal," 35% understood "orally," and 18% understood "malignant."

Other studies reported low comprehension in other critical areas of good health care, such as understanding written directions for taking medications, understanding clinical appointment slips, and informed consent forms. In a study of Medicare patients, Gazmararian et al4 found that:

• 48% did not understand the written instructions "take medicine every 6 hours"
• 68% could not interpret a blood sugar value
• 27% could not identify their next appointment
• 27% did not understand "take medicine on an empty stomach" (instructions written at fourth grade level)
• 100% could not understand a statement of Medicaid rights (written at a 10th grade level)

We tested more than 2,500 patients at two public hospitals and found that 35% of
English-speaking patients and 62% of Spanish-speaking patients had inadequate or marginal health literacy.

Patients over 60 years old have a particularly high prevalence of inadequate health literacy-- more than 80% at one of the public hospitals.

Physicians are often unaware that patients do not understand them. Patients, on their part, often feel shame over their lack of literacy skills and most often will not acknowledge this deficiency despite its interference with their care.6

Inadequate Health Literacy is Bad for Patient Health

A number of studies showed that inadequate health literacy has measurable adverse effects on patients' health. Among low-income patients with prostate cancer7, those with low literacy tended to be diagnosed later in the course of the disease, regardless of race.

Low health literacy has also been highly correlated with excessive hospitalization8, which may suggest decreased knowledge of self-care, reduced compliance and less ability to negotiate the health care system in people with marginal literacy.

Treatment compliance is yet another area affected by literacy skills. A study that looked at the significance of health literacy to other predictors of compliance to treatment for HIV and AIDS found that education and health literacy were significant independent predictors of adherence to treatment.9

Inadequate health literacy is estimated to cost the health care system from $30 billion to $73 billion annually.10

Recognizing Inadequate Health Literacy

You may not know that your patient has inadequate or marginal health literacy. The patient's level of education does not guarantee that he or she can read. A study in five family practice clinics found that over 60% of patients tested had a reading skill that was at least three levels below the school grade they completed.11 In the large Medicare survey previously described, 27% of the patients who had a high school diploma and 17% of those who had some college education had inadequate or marginal health literacy.4

To help identify patients with low literacy skills, we developed the Test of Functional
Health Literacy in Adults (TOFHLA).12 Available in English and Spanish, the test uses common materials in the health setting that require reading skills (e.g., pill bottles, standardized appointment slips, instructions for upper gastrointestinal preparation) and grades a patient's comprehension on a scale of 0 to 100. Patients who score lower than 60 points are considered to have inadequate health literacy, and often misread dosing instructions and appointment slips.

Clues that a patient may have inadequate health literacy include bringing a family member to the clinic visit or wanting to discuss materials with family, claims of forgetting reading glasses, or incompletely or inadequately filling out forms.

Toward Better Communication

Physicians can improve their communication with patients with low literacy skills by learning to recognize the particular ways in which these patients deal with communication.

Patients with low literacy skills tend to interpret words literally (e.g., thinking hypertension means "being hyper") and often have difficulty identifying key concepts (or prioritizing or distinguishing them from minor details). This difficulty with language is the most frequent area of miscommunication between physician and patient. Several types of words that physicians commonly use are difficult for these patients to comprehend, such as words denoting concepts (e.g., normal range), categories (e.g., ACE inhibitors), or value (e.g., excessive bleeding).

Another area of miscommunication is related to the lack of training in science and medicine in most patients, which can lead to logic problems. This problem can be particularly exacerbated in patients with low literacy skills because of their tendency not to acknowledge when they don't understand something.

For example, it may seem logical to patients to stop a 10-day course of antibiotics once they feel better, even though they've been instructed to take the full course. Physicians understand the science and medical implications of stopping antibiotics mid-course, but this is not clear to many patients (even those with higher levels of literacy).

Ways to improve health literacy include simplifying or clarifying patient education materials, with particular focus on the use of visual aids such as videos, pictographs and cartoons. Studies show that visual aids improve comprehension, compliance and retention.13-15 Physician involvement in delivering these materials and educating the patient are critical for enhancing health literacy.

Including family and friends in helping deliver health information is also important,
as patients with inadequate health literacy often go first to people they know for explanation.

Table 1 lists a number of key points to help enhance health literacy in the clinical setting. To help educate physicians on health literacy, the American Medical Association's Foundation has launched an initiative in this area.

References

1. National Literacy Act, 20 USC Section 1201 (1991).
2. Kirsch I, Jungeblut A, Jenkins L, Kolstad A. Adult literacy in America: at first look at the findings of the National Adult Literacy Survey.
Washington, DC: National Center for Education Statistics, US Dept of Education; 1993.
3. Gibbs R, Gibbs P, Henrich J. Patient understanding of commonly used medical vocabulary. J Fam Pract 1987; 25:176-178.
4. Gazmararian JA, Baker DW, Williams MV, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA 1999; 281:545-551.
5. Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA 1995;
274:1677-1682.
6. Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns 1996; 27:33-39.
7. Bennett CL, Ferreira MR, Davis TC, et al. Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. J Clin Oncol 1998; 16:3101-3104.
8. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med 1998; 13:851-851.
9. Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med 1999;14:267-73.
10. Friedland R. Understanding health literacy: new estimates of the costs of inadequate health literacy. Presented at the 3rd Annual Health Literacy Conference on Health Literacy. 1998.
11. Davis TC, Mayeaux EJ, Fredrickson D, Bocchini JA, Jackson RH, Murphy RW. Reading ability of parents compared with reading level of pediatric patient education materials. Pediatrics 1994; 93:460-468.
12. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med 1995; 10:537-541.
13. Houts P, Bachrach R, Witmer J, Tringali C, Bucher J, Localio F. Using pictographs to enhance recall of spoken medical instructions. Patient Educ Couns 1998; 35:83-88.
14. Houts PS, Witmer JT, Egeth HE, Loscalzo MJ, Zabora JR. Using pictographs to enhance recall of spoken medical instructions II. Patient Educ Couns 2001; 43:231-242.
15. Jacobson TA, Thomas DM, Morton FJ, Offutt G, Shevlin J, Ray S. Use of a low-literacy patient education tool to enhance pneumococcal vaccination rates. A randomized controlled trial. JAMA 1999;
282:646-650.

Suggested Reading

Baker DW, Parker RM, Williams MV, et al. The health care experience of patients with low literacy. Arch Fam Med 1996; 5:329-334. Council on Scientific Affairs for the American Medical Association. Health literacy. Report of the AMA Council on Scientific Affairs. JAMA 1999; 281:552-557.

Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest 1998; 114:1008-1015.

Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension or diabetes. Arch Intern Med 1998; 158:166-172.

2002 MHCC HMO Report Cards Released

The Maryland Health Care Commission (MHCC) recently released its annual guide for consumers on the performance of nine Maryland Health Maintenance Organizations (HMOs). The MHCC report card rates each of the Maryland HMOs on:

• Frequency members obtain preventive and wellness services
• Member satisfaction with the health care they receive
• How customers feel about their health plan

Report card results are based on the Consumer Assessment of Health Plans Survey (CAHPS) and clinical data from Health Plan Employer Data Information Set (HEDIS) audits. The report card, The 2002 Consumer Guide to Maryland HMOs & POS Plans, is published in its entirety by MHCC and is available at www.mhcc.state.md.us or by calling the Commission at 877-245-1762. CareFirst BlueChoice (BlueChoice) submitted data for the 2002 MHCC report card.

BlueChoice's performance was rated above average or average in 21 of the 34 MHCC categories. Above average performances were demonstrated in well-child visits for infants/children and comprehensive diabetes care. The health plan was named "Star Performer" for better-than-average performance over several years in the well-child visits for infants/children. The major improvements are as follows:

• 59% - Adult diabetic members' cholesterol control (47% in 2001).
• 83% - Cholesterol testing rate (76% in 2001).
• 54% - Controlling high blood pressure rate (38% in 2001).
• 28% - Adolescent immunizations, a combination of MMR, Hepatitis B and Varicella, (21% in 2001).

While acknowledging these improvements, BlueChoice continues to evaluate and implement new processes to improve care and services for its members and is committed to exploring additional initiatives to improve member satisfaction.

The National Committee for Quality Assurance (NCQA) also publishes HEDIS results and compares many HMOs on a national and regional basis in The State of Health Care Quality 2002, available at www.ncqa.org.

Magellan Behavioral Health: Postpartum Depression Program

About 70 - 80% of women with newborns experience a self-limited period of depression three to four days after delivery. Most women experience mood swings after the birth of their baby. Yet when feelings of depression overwhelm a new mother and she can't function well by her second week, there is serious cause for concern.

Unrelenting postpartum depression occurs in about 10-15% of new mothers. This is an under-detected subset of depression. Some risk factors for postpartum depression include a history of depression or anxiety, stressful life events and an unsupportive environment. The dramatic neuroendocrine changes that occur in women after delivery play an important etiological role in postpartum mood disorder. The presence of depression in a pregnant woman is still the strongest predictor of postpartum illness.

Initiative
Clinicians and members have identified postpartum women as an important population to offer services that meet their special needs. As a result, CareFirst BlueChoice, Inc. (BlueChoice) and FreeState Health Plan, Inc. (FreeState), in collaboration with Magellan Behavioral Health, have introduced a postpartum depression-screening program for new mothers enrolled in their health plans.

Since December 2001, new mothers have been mailed a packet of materials from Magellan within three weeks of delivery. These materials have been created to educate new mothers about symptoms of postpartum depression and screen for possible symptoms using the Edinburgh Postpartum Depression Scale. A Magellan care manager contacts new mothers who screen positive. The care manager further evaluates the new mother and offers resources to assist her as appropriate. Members who accept a referral for treatment are contacted after their initial appointment and at three and six months after delivery to assess their treatment outcomes and offer additional assistance as needed.

From December 2001 through August 2002, 616 mailing packets were sent to new mothers. Ten percent of new mothers returned the depression screen with 13% scoring positive for symptoms of depression. This is consistent with estimates of postpartum depression cited in the scientific literature. Twenty-five percent of these members accepted a referral for treatment, however, no members kept their first appointment. Magellan, BlueChoice and FreeState have worked together to accelerate contact with new mothers as soon after delivery as possible to increase the response rate.

Additionally, Magellan has lowered the threshold for a positive score based upon recent recommendations published in The New England Journal of Medicine. Magellan continues to analyze barriers to members following through with a referral for treatment and will implement changes to the program as appropriate.

Practitioners may assist with this program by encouraging women who have recently given birth to be alert to symptoms of postpartum depression and encourage new mothers to seek treatment.

Council for Affordable Quality Healthcare: Credentialing

CareFirst and its Council for Affordable Quality Healthcare (CAQH) colleagues continuously seek to improve the health care experience for consumers and physicians.

If you are a M.D., D.O., D.D.S., D.M.D., podiatrist or chiropractor in Washington, D.C., Maryland or Virginia, you now have access to the CAQH Universal Credentialing Datasource system, which streamlines the credentialing process.

CAQH's system pulls together and organizes comprehensive data from more than 600,000 providers nationwide, so eligible providers can avoid redundant submission of licensing, educational and practice information to participating health plans and health care organizations. Only one completed application per provider is needed.

CAQH Universal Credentialing Datasource is compliant with the Uniform Application Form regulations and streamlines the data collection and submission process into a web-enabled system that satisfies the credentialing requirements of participating health plans.

CareFirst encourages eligible providers to take advantage of this initiative. "We can simplify what has long been a tedious and repetitive administrative task; CAQH is improving the credentialing data collection process for not only health care providers, but for health plans and hospitals too," said Dave Wolf, Executive Vice President of Medical Systems and Corporate Development for CareFirst.

CareFirst will continue to perform data verification and review, as well as make independent decisions about whether a provider meets the standards for participation.

There is no cost to providers who submit applications and use the CAQH Universal Credentialing Datasource. If you are interested in using CAQH's Universal Credentialing Datasource, call CareFirst's Provider Information and Credentialing Department at 410-872-3500, or call toll-free at 877-269-9593. You will then receive a user ID that will allow access to the application on CAQH's Credentialing Web site.

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