Project Summary

The Health Resources and Services Administration (HRSA) is building a healthcare practitioner credentialing portal to streamline and simplify the credentialing of health care professionals.

Project Team

Internal Entrepreneurs
Rebecca Spitzgo, HRSA
Ernia Hughes, HRSA
Cynthia Grubbs, HRSA
Thomas Sowinski,  OIG
Tina Fuchs, OIG
Jill Wright, OIG
Richard Gilbert, CMS
Zabeen Chong, CMS

External Entrepreneur 
TBD


Project Details


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Credentialing departments in hospitals, health plans, Federally Qualified Health Centers, long term care facilities, ambulatory surgical centers and others must obtain information on health care practitioners before granting privileges or membership. State licensing boards also obtain information prior to issuing a license or certification. Health care entities are required to obtain primary source verification, requiring them to reach out to multiple collection system to obtain the necessary credentialing information. Maintaining multiple, disconnected repositories of pertinent data used to credential health care professionals is expensive and ineffectual.

HRSA is engaged in a collaborative initiative to create a central portal (a one stop shop) for stakeholders, e.g. health care licensing boards, hospital credentialing departments and health care professionals to access and obtain necessary credentialing information. The project involves consolidating  or synchronizing relevant systems, which include HRSA’s National Practitioner Data Bank (NPDB), the Centers for Medicare & Medicaid Services (CMS) National Plan and Provider Enumeration System (NPPES), the CMS Provider Enrollment, Chain, and Ownership System (PECOS), and the Office of the Inspector General’s List of Excluded Individuals/Entities (LEIE). Consolidating the credentialing portion of these systems will provide ready access to pertinent data, achieve time and cost savings; service customers more fully, enhance the integrity and quality of the collective data and achieve economies of scale, and provide a platform to pass greater savings onto users.


Background

HHS Entrepreneurs is one of our in-residence pathways that is bringing new talent into government. HHS Entrepreneurs pairs HHS employees with external expertise to work on an identified problem for a 12 month period. This project is one of five projects from the third cohort of HHS Entrepreneurs. Learn more about HHS Entrepreneurs.