Physician Credentialing

AZ_CapitolLast month, Arizona Gov. Doug Ducey and the State Legislature passed sweeping bipartisan legislation to combat Arizona’s dangerous opioid epidemic. We commend our elected leaders and all who came to the table to address this significant and urgent public health crisis.

Of course, when it comes to improving health and healthcare for Arizona people and communities, there is always more work to be done. One area that demands our attention is the issue of physician credentialing.

Credentialing is a complex process done by insurers that, when simplified, involves a) verifying that doctors are qualified to treat their members, and b) loading said doctors into their billing system so they can get paid. This is an important and necessary process that ensures only qualified physicians are administering care and treatment to insurers’ members.

The problem? It takes too long.

For example, several hospitals have reported that some insurers take 90 days or longer to complete the process in more than 50 percent of cases. In some instances, like at Tucson Medical Center, the process can take the better part of a year:

“At Tucson Medical Center, we invest millions annually to recruit new providers to Tucson. Once they arrive, they often wait months for insurance companies to move through the credentials process. We have one physician who has waited over 240 days – more than eight months – for credentialing through one Arizona insurance company. These delays are not only costly to physicians, hospitals and the state – they’re prohibitive to efficient, effective patient care.” Julia Strange, Vice President of Community Benefit, TMC.

This issue has become especially problematic for regional and small rural hospitals that already struggle with physician recruitment and retention.

“Regional hospitals like Yuma Regional Medical Center are becoming increasingly impacted by the current credentialing process. Hospitals like ours already have a hard enough time recruiting qualified doctors to the region in the first place. A credentialing process that delays for months their ability to see patients and get paid only serves to compound the problem.” said Dr. Bharat Magu, Chief Medical Officer, Yuma Regional Medical Center.

“A burdensome, time-consuming and costly credentialing process is one of the many issues we disproportionately face as a small rural hospital,” said Neal Jensen, CEO, Cobre Valley Regional Medical Center in Globe. “In most instances, we’re having to go into our own pocket to pay physicians to see patients, simply because there are so few doctors in the community and we can no longer wait around for insurers. This is care for which we’re not reimbursed, but which we continue to provide because we’re committed to caring for every patient who walks through our doors.”

All patients understandably and rightly want to be sure their physicians are competent and well-trained. Unfortunately, the process has become increasingly arduous, frustrating and expensive.

That’s why AzHHA is proud to support a bill before the state legislature – HB 2322 – which requires insurers to approve or deny credentials within 60 days and load approved providers into their billing system with an additional 10 days. This legislation would provide an ample, reasonable amount of time for insurance companies to complete the process and allow doctors to get to work doing what they do best: caring for patients.

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