HOUSE JOINT MEMORIAL 3

49th legislature - STATE OF NEW MEXICO - second session, 2010

INTRODUCED BY

Danice Picraux and Dede Feldman

FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE

A JOINT MEMORIAL

REQUESTING THE INSURANCE DIVISION OF THE PUBLIC REGULATION COMMISSION TO CONVENE A TASK FORCE TO DEVELOP A SINGLE STATEWIDE PROCESS FOR THE CREDENTIALING OF HEALTH CARE PRACTITIONERS.

     WHEREAS, credentialing is the process of obtaining, verifying and assessing the qualifications of a health care practitioner to provide care or services in or for a health care organization; and

     WHEREAS, the process of credentialing includes primary source verification by which the reported qualifications of an individual practitioner are verified by the original source or an approved agent of that source of information; and

     WHEREAS, credentialing of a health care practitioner must occur in order for the practitioner to bill and to be reimbursed for care or services provided by an insurer or health plan; and

     WHEREAS, the process of credentialing is time consuming and can take up to one hundred twenty days to complete; and

     WHEREAS, the process is one that is performed and duplicated multiple times by individual health care practitioners, hospitals, health plans and clinics, all of which have credentialing committees and staff dedicated to ensuring the completion of the paperwork and to ensure the applications are processed on a timely basis; and

     WHEREAS, in the past, only medicare required credentialing, but today, virtually all payer sources require credentialing before payment can be made for care or services provided; and

     WHEREAS, following the initial credentialing process, health care practitioners must be re-credentialed at least every two years; and

     WHEREAS, entities exist that perform the primary source verification of the information provided in the credentialing application, but health care practitioners still must complete the paperwork to submit the application multiple times; and

     WHEREAS, the New Mexico medical society has collaborated with the New Mexico medical board and the hospital services corporation to create a uniform application process that insurers and health plans will accept, but some insurers and health plans utilize a different application for credentialing; and

     WHEREAS, the hospital services corporation maintains a database of information for the applications it processes; however, some insurers and health plans utilize a different national organization to maintain a database of credentialing information, resulting in no centralized database of credentialing information; and

     WHEREAS, the insurance division of the public regulation commission recently promulgated new regulations that require the use of a uniform credentialing application and that processing of that application take no longer than forty-five days, but these regulations govern only managed care organizations; and

     WHEREAS, state law requires the human services department to negotiate with medicaid contractors to ensure that contractors' credentialing requirements are coordinated with other credentialing processes required of individual providers; and

     WHEREAS, despite these recent regulations and state statute, evidence has not yet been seen to support the simplification of the credentialing process for New Mexico health care practitioners; and

     WHEREAS, the creation and implementation of a consolidated single credentialing process would greatly contribute to reducing what is currently an expensive, duplicative, time-consuming and administratively burdensome process; and

     WHEREAS, there is a need to align multiple credentialing processes among multiple payers;

     NOW, THEREFORE, BE IT RESOLVED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO that the insurance division of the public regulation commission be requested to convene a task force to develop a single statewide process for the credentialing of health care practitioners; and

     BE IT FURTHER RESOLVED that the membership of the task force include representatives from the New Mexico medical society, the San Juan independent practice association, the New Mexico nurse practitioner council, all health plans with medicaid contracts, the New Mexico hospital association, the hospital services corporation, the New Mexico primary care association and the New Mexico medical board and from at least two private insurers; and

     BE IT FURTHER RESOLVED that the findings and recommendations of this task force be reported to the interim legislative health and human services committee by November 2010; and

     BE IT FURTHER RESOLVED that copies of this memorial be transmitted to the insurance division of the public regulation commission and the human services department.

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