|Well, they are not exactly trouble makers but if you do not pay attention on occasion to these outside entities you can have some difficulties. In the course of contracting for our new clients and re-contracting for our older clients we run into various roadblocks or issues from the Council for Affordable Quality Healthcare (CAQH), Provider Enrollment, Chain and Ownership System (PECOS), the National Plan & Provider Enumeration System (NPPES) and some of the payers. I am starting to wonder if the longer the name the more difficult with which they are to work but I digress… Below are some ideas for keeping your information up to date so you are not spending time and money correcting things later.
CAQH – CAQH started as a time saving measure. Its role, which they’ve actually performed quite well, was to be a central repository for credentialing information. Prior to CAQH, every payer had a different credentialing form which asked the same questions in a variety of different ways. Because they are now the central repository by which commercial payers decide if you are a qualified physician to be on their panel it is essential to keep this information updated.
They ask that you log into CAQH and re-attest quarterly. I haven’t met a physician so far that keeps that sort of schedule with CAQH. I do recommend that you review your CAQH information and re-attest at least annually. Pick a date like your date of birth or the first of the year. Review the information. Double check the address, telephone number, any emails, listed affiliations, and medical-legal issues you might have had. The commercial payers review your credentials every three to five years. If your CAQH information is woefully out of date, they could (and have) summarily terminate a physician’s contract.
PECOS – I will admit this system is a bit more difficult to navigate. Again, on an annual basis, I would dial into the PECOS system and review the information contained therein. If you are a physician/owner of a practice, the first thing I would look for is the information on the practice you own. If it is not ‘linked’ to you this can create a large number of complications later. On the bottom of the My Associations tab you should find your name and your practice’s name. No practice tab? Start contacting them.
In your tab, be sure to review your affiliations. You may find that they have a list of companies with whom you used to work – literally years ago quite often. These should be submitted for deletion from your PECOS profile. I would double check your name, address, other information contained in other sections. It will also note if you need to revalidate. If so, you or whomever you work with for this service, should begin that process as well. Failure to revalidate can cost you literally thousands of dollars in unpaid claims.
In the practice tab if you are a physician/owner, you should review the address, telephone number, contact information (which frequently is out of date), and who is affiliated with your practice. If you have mid-levels or other physicians, they should be listed in this set of fields as well. Be sure your mailing address is completely correct and the special payments address is correct as well. If the practice information is in need of revalidation, it will note that as well.
NPPES – They are the issuer and hold the information on your Type 1 (personal) and Type 2 (practice, if you are a physician/owner) National Provider Identifier number (NPI). You should review your specific information, your taxonomy and other elements annually as well. The Type 2 information needs to match up with your IRS information in terms of spelling and punctuation. This can be critical down the road when dealing with Medicare. Be sure the address and contact information matches what you have listed in PECOS. In both records you should update your associated identification numbers like PTANs, Medicaid ID numbers, and the like.
While all of this sounds time consuming, and it may well be the very first time you review your data, it should become quite routine and rather quick thereafter. Having accurate and complete information about you and your practice available for the payers and Medicare is rather essential for today’s electronically connected practice.