OAR 409-045-0050
Credentialing Organization Participation
(a) Enroll in the system no later than two months prior to the mandated program start date. After the mandated program start date has passed, new credentialing organizations must enroll in the system prior to credentialing health care practitioners;
(b) Be allowed to complete their preferred health care practitioner credentialing or recredentialing processes for applications in progress prior to the mandated program start date;
(c) Obtain health care practitioner credentialing information from the system beginning on the mandated program start date to the extent the information is available;
(d) Direct health care practitioners needing to be credentialed or recredentialed to enter and maintain their credentialing information in the System beginning on the mandated program start date; and
(e) Not request credentialing information from a health care practitioner if that information is available through the system, but may request additional credentialing information not available through the system from a health care practitioner or conduct additional verifications if necessary for the purpose of completing credentialing procedures as required by the credentialing organization.
(f) Pay a one-time set-up fee to the Authority based on health care practitioner panel size, assessed on the mandated program start date. After the mandated program start date has passed, new credentialing organizations shall pay a one-time fee based on health care practitioner panel size which is due upon enrollment in the system.
(g) Pay an annual subscription fee to the Authority, based on health care practitioner panel size, assessed on the first day of the new program year in alignment with the mandated program start date, beginning on the mandated program start date. After the mandated program start date has passed, new credentialing organizations shall pay an annual fee based on health care practitioner panel size. The fee is due upon enrollment in to the system and every 12 months thereafter.
(h) Identify health care practitioner panel size using a full count of its credentialed health care practitioners in which a decision to credential the health care practitioner is made by the credentialing organization.
(2) Credentialing organizations may not include in their health care practitioner panel size fully delegated health care practitioners in which the decision is made by a separate credentialing organization.
(3) An organization may provide a written attestation to being a health system using a process defined by the Authority. In cases where a credentialing organization is not majority controlled or majority owned, but where the health system has a management relationship or maintenance of an ownership interest in the organization, the health system may request the organization to be considered as part of the health system. The Authority shall:
(a) Identify a process for the written attestation and provide a health system request form on the program’s website at http://www.oregon.gov/oha/HPA/OHIT-OCCP; and
(b) Evaluate health system requests and make a determination with consideration to a management relationship or maintenance of an ownership interest.
(4) Health systems shall:
(a) Ensure each credentialing organization sets up an individual profile in the system; and
(b) Be placed into a collective fee tier based on the practitioner panel size using a count of its credentialed health care practitioners deduplicated to represent a unique practitioner count across the health system.
(5) Health systems may not include in their health care practitioner panel size fully delegated health care practitioners in which a decision is made by a separate credentialing organization outside the system.
(6) An organization may provide a written attestation to being an integrated delivery network through a process defined by the Authority. The Authority shall identify a process for the written attestation on the program’s website at http://www.oregon.gov/oha/HPA/OHIT-OCCP.
(7) Delegated credentialing agreements between credentialing organizations and centralized credentialing processes within health systems may be used to the extent they do not include the separate collection of credentialing information and verifications available in the system.
(8) A prepaid group practice health plan that serves at least 200,000 members in Oregon may petition the Director to be exempt from the requirements of this section. The Director may grant the petition if the Director determines that subjecting the health plan to this section is not cost effective. If the Director grants an exemption, the exemption also applies to any health care facilities and health care provider groups associated with the health plan. For purposes of this section, associated health care facilities and health care provider groups means health care facilities that are operated primarily to serve the health plan’s members, medical or dental groups that contract exclusively with the health plan, and employees of the health plan, associated health care facilities, or associated health care provider groups. Exemptions may be reviewed by the Authority every two years for validity. The petition for exemption must be submitted to credentialing@state.or.us and include:
(a) The name of the prepaid group practice health plan petitioning the Authority and the associated health care facilities and health care provider groups to be covered under the exemption;
(b) The phone number and email address for the health plan contact individual;
(c) A description of the prepaid group practice health plan;
(d) A brief description of the prepaid group practice health plan’s current credentialing practices; and
(e) A justification of why the system is not cost effective.
Source:
Rule 409-045-0050 — Credentialing Organization Participation, https://secure.sos.state.or.us/oard/view.action?ruleNumber=409-045-0050.