NAMSS Payer Credentialing Roundtable REPORT

Following on the success of the 2014 roundtable discussion regarding facility credentialing, the National Association Medical Staff Services (NAMSS) convened a roundtable on May 7, 2015, of notable industry representatives to introduce and discuss the essential data elements for practitioner credentialing with payer organizations. At present, practitioner credentialing, while required within multiple areas of the healthcare industry, is time-consuming, inefficient, and depletes resources that would otherwise be available to deliver higher quality patient care.

NAMSS has identified and vetted the essential data elements to recognize where standardization would create a more efficient and effective process. NAMSS’ assessment includes a thorough review of the current credentialing system to identify efficiencies and deficiencies.

The Payer Credentialing Roundtable participants represented the following 13 entities: Aetna, Cigna, Kaiser Permanente, Blue Cross Blue Shield of Michigan, Health Net, Horizon Blue Cross Blue Shield of New Jersey, the American Hospital Association, the American Medical Association’s Organized Medical Staff Section, the Council for Affordable Quality Healthcare, the National Committee for Quality Assurance, the Medical Group Management Association, and the Health Resources and Services Administration.

Download NAMSS' Payer Credentialing Roundtable Report