| Question: What is the purpose of the uniform application? |
Answer: The uniform application reduces the paperwork burden for practitioners applying for hospital privileges or for participation in a healthplan by eliminating the need to fill out a different application for each hospital and healthplan. Instead, the same application can be submitted to any hospital and healthplan in Georgia that accepts the uniform application. The practitioner can fill out the uniform application and save it in the office computer. When the practitioner wants to apply to a hospital or healthplan, the application can simply be updated if necessary, printed out, signed and dated, and submitted along with the appropriate Part 2.
| Question: What is the Part 2? |
Answer: The uniform application includes information needed by both hospitals and healthplans for appropriate credentialing. However, healthplans also need information not required by hospitals and visa-versa. Additionally, the JCAHO requires that some things, such as physician privileges, be hospital specific. Part 2’s answer these needs.
The healthplans have a uniform Part 2 which is included in this website and can be downloaded, completed, and stored in your office computer along with Part 1. Each hospital has a unique Part 2 that must be obtained directly from each hospital. Most are a single page and include such things as the privileges you are requesting, who will take call for you, and other hospital-specific questions. You may also receive the hospital’s bylaws and an attestation that you will abide by the bylaws and hospital rules and regulations, etc.
| Question: Who accepts the uniform application? Is it required by the State? If so, what is the effective date of the requirement? |
Answer: Use of the uniform application is voluntary; there is no State requirement that a hospital or healthplan accept it. However, the UHPCAF Committee is not aware of any hospital or healthplan in Georgia which does not accept the application. If you know of a hospital or healthplan which will not accept it, please notify the Webmaster, so that we can contact them and encourage their participation. (Note: Reportedly some hospitals will send a different application if one is requested; however, they also accept the uniform application.)
| Question: Who should use the Uniform Healthcare Practitioner Credentialing Application Form (UHPCAF) and how is it different from the Uniform Healthcare Allied Health Professional Credentialing Application Form (UHAHPCF)? |
Answer: UHPCAF is intended for physician’s use. However, some hospitals and plans may also use it for psychologists, podiatrists, and other practitioners. UHAHPCF was developed for use by Physician Assistants, Nurse Practitioners, and other allied health professionals. If you are not a physician, you may wish to contact the entity to which you are applying to determine if you should use the UHPCAF, or the one for Allied Health Professionals.
| Question: What is the difference between the UHPCAF on this website and the CAQH application? |
Answer: This UHPCAF cannot be completed on-line. You must download the application, complete it and save it in your computer. It is then available for you to update whenever the need arises (e.g. a new DEA or license expiration date, change in malpractice insurance, or board certification). When you apply to a healthcare entity, print out a copy of the application from your computer, sign and date it, and submit it with the appropriate Part 2.
The CAQH application is completed on-line at its secure site (http://www.caqh.org/). You will be prompted periodically by CAQH to make any needed updates on-line. If you have authorized it, a participating healthplan can download your application, which will print out in the UHPCAF format. Participating healthplans to which you belong will also be notified by CAQH whenever you update your licenses/insurance/etc. If you have not authorized release of the application, or if the healthcare entity to which you are applying is not a CAQH participant, you can download the completed application from the CAQH website for submission to a hospital or plan, along with the appropriate Part 2.
| Question: I’ve completed the application. Now all I have to do is submit it to any hospital or healthplan in Georgia, right? |
Answer: Not quite. Remember to complete the healthplan Part 2 if you are applying to a healthplan and to contact the hospital for its Part 2 if you are applying to a hospital. In addition, some hospitals require a pre-application; healthplans may also have additional requirements before they will accept your application. Contact the hospital or healthplan to which you plan to apply first.
| Question: Isn’t the language on peer review information in Schedule A too broad? Could an attorney, for instance, request/obtain my confidential information? |
Answer: The peer review language on this application is the same as in prior applications. For the protection of patients it is essential that credentialing committees can assess the current clinical competence of an applicant for privileges or for reappointment. Georgia law specifically authorizes the exchange of peer review information between peer review committees without any loss of confidentiality privileges. Credential committees are deemed peer review committees. Georgia law does not permit attorney access to that credentialing information. Information can be disclosed only to the extent that the disclosure does not affect the peer review privilege, or as otherwise required by law.
| Question: I already have a physician database. Can I obtain UHPCAF in a non-protected format, so I can bookmark it and populate the needed information directly from my database? |
Answer: No. To protect the integrity of the application, we cannot make it available in a non-protected format.
| Question: I have received a reappointment request that included a blank UHPCAF reappointment form. I already completed it on-line. How can I find a copy of this to send in for my reappointment? |
Answer: The appointment/reappointment forms cannot be completed on-line. If you have done so, the information you included was lost when you closed the site. The applications (appointment and reappointment) can be downloaded into your computer or to a disk and completed/saved there. You can then update the applications, print out copies, sign and date them, and submit them to the appropriate hospital or healthplan for appointment or reappointment.
| Question: If my circumstances change and I obtain a new EIN number do I need to apply again to each healthplan or do I fill out the reappointment form? |
Answer: Update a reappointment application and send with a cover letter to each plan indicating the new EIN number and any changes in practice name or address.
| Question: Will my completed uniform application be sent to all insurance carriers in Georgia so that I am qualified to receive reimbursement for services? |
Answer: No. The uniform application is here for your convenience, but you must still download it, complete it, and save it in your computer to print/sign/date and submit to any healthcare entity to which you wish to apply. If you choose to use the CAQH application, you must still authorize to whom it can release your data, and you must still apply to the healthcare entity – CAQH will not release your application without your authorization, and, if the entity to which you are applying is not a CAQH participant, you will still have to download the application and submit it yourself.
| Question: I have completed my application. How do I send it to you? |
Answer: We do not accept completed applications. You must submit them to the healthcare entity to which you wish to apply. Please contact them first to be sure that they are accepting new applications, to obtain their Part 2 from a hospital, and to ascertain any other application requirements of the healthcare entity.
| Question: Schedule B claims information form requires the patient name and age. Is this permitted under HIPAA? |
Answer: HIPAA does permit release of protected health information required for treatment, payment and healthcare operations. Credentialing is a part of healthcare operations. Appropriate credentialing is essential for quality patient care and a paramount administrative need. Credentialing committees, which are peer review committees, need complete information in order to fulfill their responsibilities.
| Question: Why hasn’t GAMSS, GHA or the Georgia Healthcare In-House Counsel Association endorsed the CAQH electronic application process? |
Answer: The groups mentioned have not endorsed the CAQH application but neither do any of them oppose it. The choice is left to the individual hospital or healthplan. There is no charge for physicians who utilize the CAQH application. Hospitals or managed care plans which elect to participate must pay CAQH an annual fee, in addition to a fee for each physician member of their staff/plan. The listed organizations believe it is inappropriate to endorse a program which might prove too costly for the hospital/plan. For those healthcare entities which find CAQH cost effective, participation is an available option.
The UHPCAF sponsoring organizations support reduction of physician paperwork through use of the Georgia uniform healthcare practitioner credentials application, whether it is through this site or the CAQH electronic website.