Colorado Medical Society

WHEREAS, much of the health insurance plans' credentialing process is subjective in nature, and includes application questions that appear accusatory and/or are open-ended, and

WHEREAS, many health insurance plans are using a common, centralized collection service through the Coalition for Affordable Quality Health Care (CAQH) for the purpose of credentialing physicians, which limits the ability of the state medical societies to affect changes to these type of questions at the local level, and

WHEREAS, a resolution was submitted to the 2004 AMA Annual Meeting by our Delegation calling for policy to stop these accusatory practices, but was instead used to reaffirm current AMA policy H-435.963 Professional Liability Claims Reporting, therefore be it

RESOLVED, that CMS adopt AMA Policy H-435.963 Professional Liability Claims Reporting, as stated below:

The CMS opposes the need for reporting on medical staff and other non-licensing board applications, including insurance company credentialing applications, (except for professional liability insurance applications) any threatened, pending, or closed professional liability claims where the claim did not result in payment on behalf of that physician, and be it further

RESOLVED, that our CMS establish policy that credentialing applications should not contain questions that are subjective and accusatory in nature such as:

"Have you ever received sanctions from or been the subject of investigation by any regulatory agencies (e.g., CLIA, OSHA, etc.)?" or,

"Have you ever had any malpractice actions (pending, settled, dropped, dismissed, arbitrated, mediated or litigated)? If yes, provide information for each case".

In addition, the policy should also state that a limitation of not more than five years be placed on the centralized credentialing collection services to implement this policy.

FISCAL IMPACT: None