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Using MSOW to Automate Managed Care Meeting Agendas Cheryl Cisneros, CPMSM, CPCS, BSN Manager, Advocate Health Care CVO
Using MSOW to Automate Managed Care Meeting Agendas
Cheryl Cisneros, CPMSM, CPCS, BSNManager, Advocate Health Care CVO
Building the Agenda
Process Development
Workflow & Accountability
Agenda Conventions
Completing the Agenda
Maximizing MSOW to Report Data
Process Development
Initial and RecredentialingProcess for Each Facility or Not(MSONet & Launch of Application)
Delegation Requirements(NCQA, AAAHC URAC, etc.)
Organization Specific RequirementsJob/Task – Consistent Language
Creating the Process Menu⇒Workflow⇒Manager⇒ Organize Process
Initial Credentialing Process
Recredentialing Process
Workflow & Accountability
Initial Credentialing: Coordinator
Recrecentialing: Team
Job/Task: Consistent Naming Process Name & Process Code
Consistent Reasonable Process and Completion Timeframes
Agenda ProcessesFoster Transparency
Agenda: Communication Tool
MSOW Users: View Only Permissions(Provider Relations, Recruiter, etc.)
Documentation: Task Level Notes
Process Archive Summary Reports
ConventionsInitial and Recredentialing
Work Group Completes
Establish Conventions @ Task Level
Select Tasks to Display on Agenda
Comments Displayed on Agenda
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
Recredentialing Process Audit Report Conventions
Task Description Task Complete Date Comments- Displayed on Agenda
Current ILCS w/office address & all schedules Or Current DEA w/IL office address & all schedules
Date Task Completed Clean File – Leave Blank Issue Comments: According to Conventions
ILCS &/or DEA – Home Address
Current Malpractice Certificate
Date Received Leave Blank
NPDB-HIPDB Reviewed Date Task Completed Leave Blank
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 Issue Comments:
NPDB HIPDB-Licensure Action HIPDB – Medicare/Medicaid Sanctions
Compliant w/QI Activities
Date Task Completed Clean File Leave Blank 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
MSOW Custom Agenda Reports
Name Facility Status Category
Doctor One, DPM ABC Applicant SpecialistDoctor Two, MD XYZ Applicant Specialist
Doctor Three, MD ABC Applicant Primary CareDoctor Four, MD XYZ Applicant Primary Care
Doctor Five, DO ABC Applicant SpecialistDoctor Six, MD ABC Applicant SpecialistDoctor Seven, MD ABC Applicant Specialist
TESTCredentialing Committee Agenda
01/01/2010Specialty Comments
Appointment - No Issues Present
Appointment - Not Board Certified (No Discussion Required)Obstetrics & Gynecology Not Board Cert - taking Part I 6/10Obstetrics & Gynecology Not Board Cert - taking Part I 6/10
Foot SurgeryVascular Surgery
Plastic Surgery Hospital Verification - Disciplinary ActionRadiology Licensure Action
Appointment - Issues PresentRadiology NPDB-$1,000,000 settlement
Name Facility Status Category
Doctor Eight, MD CONDPHO Active SpecialistDoctor Nine, MD CONDPHO Active SpecialistPhysician Assistant Ten, PA CONDPHO Active Specialist
Nurse Practitioner Eleven, NP LGHPHO Active Specialist
Doctor Twelve, MD TRINPHO Active Primary Care
Doctor Thirteen, DO SSHPHO Active Primary Care
Doctor Fourteen, DPM SSHPHO Active Primary Care
Doctor Fifteen, DMD LGHPHO Active Specialist
2008 MCO Failed Medical Record Audit
ILCS - Home AddressDEA - Home Address
Internal Medicine NPDB/HIPDB - Illinois Licensure Action & $1,000 fine
Reappointment - Issues
Reappointment-QI Study NonCompliance & Fail Medical Record Audit
Medical Oncology
Reappointment - ILCS &/or DEA Home AddressPulmonary Disease
Maternal & Fetal Medicine NPDB- $250,000 Settlement
Internal Medicine 2009 MCO Failed Medical Record Audit
Reappointment - Failed Medical Record AuditInternal Medicine
TEST Recredentialing Committee Agenda
01/01/2010Specialty Comments
Reappointment - No Issues PresentInfectious DiseaseUrology
Managing WorkUsing Crystal Reports
Open Application Process Report
Open Recredential Process Report
Managed Care Open Application andRecredentialing
Verification Process Reports
Coordinator Name
Facility PracName Start Total CommitteeDate # Days Decision
Date
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