Clarification offered on Aperture’s universal credentialing process

Clarification offered on Aperture’s universal credentialing process

Failing to respond can put doctors at serious risk of being dropped from the network.

Doctors due to credential or re-credential can access guidance that helps them navigate a new, universal credentialing process among 10 managed vision care plans and optical organizations.

Launched by the National Association of Vision Care Plans (NAVCP) earlier this spring, the Universal Credentialing Initiative allows doctors to re-credential simultaneously among the plans in which they participate, purportedly streamlining the process and lowering administrative costs associated with managing multiple re-credentialing requests. Although there will be one process for these vision plans, each plan will still make its own independent credentialing decision. Such participating plans include:

  • AlwaysCare
  • Davis Vision
  • EyeMed
  • eyeQuest
  • MESVision®
  • National Vision
  • UnitedHealthcare/Spectera Eyecare Networks
  • Superior Vision
  • Vision Benefits of America®
  • VSP® Vision Care

Contracted to manage the model's administration—namely, primary source verification of doctors' credentials—Aperture Credentialing reaches out to doctors to verify information. These credential verifications can be required of any health or vision plan that doctors contract with, and failing to respond can put doctors at serious risk of being dropped from the network.

How to ensure a smooth credentialing process
Providers due to re-credential with a participating plan will receive an email—the subject line will state, Important Credentialing Information Requested: (Provider Name) (Tracking Number)—or a letter from Aperture Credentialing about 120 days in advance of their designated re-credentialing date, Aperture states. Upon receipt of this email, follow these steps:

  1. Log on to proview.caqh.org to determine the required information; make sure all documents are current and complete; ensure you are in "Initial Application Complete" or "Re-attestation" status with the Council for Affordable Quality Healthcare (CAQH).
  2. Upload your current Professional Liability Declaration Page to CAQH. This documentation must be complete, current and accurate, and simply re-attesting will not suffice based on requirements from several of the plans' clients, many of whom audit the plans to ensure the Professional Declaration Page is complete and current. Aperture suggests to always upload the new document once it has been received.
  3. Check the box for each plan that you participate with on the CAQH "Authorize" tab. Aperture will not be able to access your data unless these boxes are checked.
  4. Update the Malpractice Claim Reporting (Section 8 Disclosure Question No. 19). CAQH collects only malpractice claims from the past 10 years, so update as appropriate.

Once the CAQH application has been updated, Aperture will retrieve the information and perform primary source verification of credentials. There may be additional information required from the doctor, but following the above steps should minimize the need for multiple follow-ups. If additional information is requested, it's important to respond to Aperture in a timely fashion.

AOA appeals for simplicity, clarity
Rollout of the Universal Credentialing Initiative wasn't without its bumps. AOA has not supported or participated in this NAVCP initiative, but NAVCP has made some limited changes based on AOA's objections.

Initially, Aperture's messaging to doctors proved easily mistaken for spam or phishing attempts with alphanumeric codes in the subject line and a "donotreply" email sender, as well as a short response timing before a plan's termination notice was implemented. AOA noted these concerns to the NAVCP earlier this year, resulting in visible changes to Aperture's current communications.

This most recent credentialing clarification was circulated in a letter signed by Julian Roberts, NAVCP executive director; Charlie Falcone, Aperture Credentialing CEO; and Sorin Davis, CAQH marketing director. AOA Immediate Past President Steven A. Loomis, O.D., met with Davis and CAQH earlier in 2016 to ensure that this NAVCP initiative would not lead to a barrier between doctors of optometry and CAQH or health plan networks.

July 15, 2016

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