RD308 - Health Care Provider Credentialing Work Group Final Report

Executive Summary:

The General Assembly directed the Secretary of Health and Human Resources to convene a work group of key stakeholders in order “to gather information and make recommendations on how the Commonwealth could develop or procure a statewide centralized primary source verification system (CPSVS) that can be relied upon by the Commonwealth and its health carriers, health care providers, hospitals, and health systems for health care provider credentialing." The Secretary of Health and Human Resources delegated this work group to the Virginia Department of Health (VDH) for implementation. VDH convened a work group that met five times between July 2020 and December 2021.

The work group found that:

• No existing state agency has the current IT capability to build a CPSVS – Neither VDH nor the Department of Health Professions (DHP) have the in-house knowledge or expertise to build a system of the necessary complexity that a CPSVS would entail, and thus procurement of a future CPSVS is recommended.

• DHP and managed care health insurance plan carriers already utilize centralized systems for health care providers’ data – There are already efforts underway to centralize and reduce repetitive data filings by health care providers and the work group recommends that any future CPSVS or centralization efforts support and integrate with these existing systems.

• Pilot program or phased implementation is recommended – Other jurisdictions have attempted centralized credentialing of health care providers, using various models and experiencing varying levels of success. The work group recommends that any future CPSVS be piloted or phased in, but did not make a recommendation about which state had the preferred model.

• No consensus was reached on the “home" of a CPSVS – There are at least four state agencies with varying levels of oversight and involvement in the different components that make up the credentialing process. The work group did not reach a consensus and as a result did not make a recommendation about which existing state agency, if any, were the appropriate “home" for a future CPSVS.