Using MSOW to Automate Managed Care Meeting Agendas. Cheryl Cisneros, CPMSM, CPCS, BSN Manager, Advocate Health Care CVO
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1 Using MSOW to Automate Managed Care Meeting Agendas Cheryl Cisneros, CPMSM, CPCS, BSN Manager, Advocate Health Care CVO
2 Building the Agenda Process Development Workflow & Accountability Agenda Conventions Completing the Agenda Maximizing MSOW to Report Data
3 Process Development Initial and Recredentialing Process for Each Facility or Not (MSONet & Launch of Application) Delegation Requirements (NCQA, AAAHC URAC, etc.) Organization Specific Requirements Job/Task Consistent Language
4 Creating the Process Menu Workflow Manager Organize Process
5 Initial Credentialing Process
6 Recredentialing Process
7 Workflow & Accountability Initial Credentialing: Coordinator Recrecentialing: Team Job/Task: Consistent Naming Process Name & Process Code Consistent Reasonable Process and Completion Timeframes
8 Agenda Processes Foster Transparency Agenda: Communication Tool MSOW Users: View Only Permissions (Provider Relations, Recruiter, etc.) Documentation: Task Level Notes Process Archive Summary Reports
9 Conventions Initial and Recredentialing Work Group Completes Establish Task Level Select Tasks to Display on Agenda Comments Displayed on Agenda
10 Initial Credential Process Audit Report Conventions Task Task Complete Date Comments- Displayed on Agenda Agreement Received Date Received Leave Blank Current Malpractice Date Received Leave Blank Board Certified Date Task Completed Leave Blank (If Board Certified) Issue Comments: According to Conventions Not Board Cert took Part I 6/09 Not Board Cert passed Part I 6/08, taking Part II 10/09 Hospital Appointment Date Date Task Completed MSOW - 8/25/09 V - 8/25/09 NA - Hospitalist Program No Malpractice Cases Date Task Completed Clean File Leave Blank Issue Comments: NPDB-$500,000 & $1.0 million settlement 7 claims: 4 dismissed, 3 pending No Sanction Activity Date Task Completed Clean File Leave Blank Issue Comments: According to Conventions NPDB HIPDB-Licensure Action HIPDB Medicare/Medicaid Sanction Issues Identified Date Task Completed Clean File Leave Blank Issue Comments: i.e. Criminal Action Managed Care Complete Date File Complete Comments Leave Blank Committee Decision Date Committee Date Comments Leave Blank
11 Recredentialing Process Audit Report Conventions Task Description Current ILCS w/office address & all schedules Or Current DEA w/il office address & all schedules Task Complete Date Date Task Completed Comments- Displayed on Agenda Clean File Leave Blank Current Malpractice Certificate Date Received Leave Blank NPDB-HIPDB Reviewed Date Task Completed Leave Blank Issue Comments: According to Conventions ILCS &/or DEA Home Address Board Certified Date Task Completed Leave Blank if Board Certified Issue Comments: Not Board Cert took Part I 6/09 No Malpractice Cases Date Task Completed Clean File Leave Blank Issue Comments: NPDB-$500,000 Settlement No Sanction Activity Date Task Completed Clean File Leave Blank Compliant w/qi Activities Date Task Completed Clean File Leave Blank Issue Comments: NPDB HIPDB-Licensure Action HIPDB Medicare/Medicaid Sanctions Issue Comments: Year Study Noncompliance No Failed Medical Record and/or Site Audit Date Task Completed Clean File Leave Blank Issue Comments: Year Failed Medical Record &/or Site Audit Issues Identified Date Task Completed Clean File Leave Blank Issue Comments: Criminal Action Managed Care Complete Date File Complete Comments Leave Blank Committee Decision Date Committee Date Comments Leave Blank
12 MSOW Custom Agenda Reports
13 TEST Credentialing Committee Agenda 01/01/2010 Name Facility Status Category Specialty Comments Appointment - No Issues Present Doctor One, DPM ABC Applicant Specialist Doctor Two, MD XYZ Applicant Specialist Foot Surgery Vascular Surgery Appointment - Not Board Certified (No Discussion Required) Doctor Three, MD ABC Applicant Primary Care Doctor Four, MD XYZ Applicant Primary Care Obstetrics & Gynecology Not Board Cert - taking Part I 6/10 Obstetrics & Gynecology Not Board Cert - taking Part I 6/10 Appointment - Issues Present Doctor Five, DO ABC Applicant Specialist Doctor Six, MD ABC Applicant Specialist Doctor Seven, MD ABC Applicant Specialist Radiology Radiology Plastic Surgery NPDB-$1,000,000 settlement Licensure Action Hospital Verification - Disciplinary Action
14 TEST Recredentialing Committee Agenda 01/01/2010 Name Facility Status Category Specialty Comments Reappointment - No Issues Present Doctor Eight, MD CONDPHO Active Specialist Doctor Nine, MD CONDPHO Active Specialist Physician Assistant Ten, PA CONDPHO Active Specialist Infectious Disease Urology Medical Oncology Reappointment - ILCS &/or DEA Home Address Nurse Practitioner Eleven, NP LGHPHO Active Specialist Pulmonary Disease ILCS - Home Address DEA - Home Address Reappointment-QI Study NonCompliance & Fail Medical Record Audit Doctor Twelve, MD TRINPHO Active Primary Care Internal Medicine 2009 MCO Failed Medical Record Audit Reappointment - Failed Medical Record Audit Doctor Thirteen, DO SSHPHO Active Primary Care Reappointment - Issues Doctor Fourteen, DPM SSHPHO Active Primary Care Doctor Fifteen, DMD LGHPHO Active Specialist Internal Medicine Internal Medicine Maternal & Fetal Medicine 2008 MCO Failed Medical Record Audit NPDB/HIPDB - Illinois Licensure Action & $1,000 fine NPDB- $250,000 Settlement
15 Managing Work Using Crystal Reports Open Application Process Report Open Recredential Process Report
16 Managed Care Open Application and Recredentialing Verification Process Reports Coordinator Name Facility PracName Start Total Committee Date # Days Decision Date
17 Discussion & Questions
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