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Submiting Physician Applications

By Underwriting

pdf  pdf  pdf
Quick Reference Guide External User Enrollment Form Proof of Insurance Request Form

 

Duration: 9:42

This is a video walk through of how submit a physician application for CRICO coverage.

Transcript

Welcome to the CRICO Underwriting Training Series.  This video features information about how to complete and submit a physician application.

Physician applications are required to be completed and submitted to CRICO Underwriting for the following situations:

  • All new physicians including physicians who are joining CRICO for the first time and physicians who are returning to the CRICO program after having insurance elsewhere.
  • Any existing physicians changing their specialty classification.  Please note a change in specialty requires a delineation of privileges (DOP) and any additional documentation necessary (e.g., procedure listing) in order to process. The effective date of the change will be the date of the revised DOP.
  • Any existing physicians changing their:
    • Sponsoring Institutions and/or primary employer
    • Status (e.g., resident to fellow, fellow to staff)
    • Returning from a leave of absence of 3 months or greater

      Please note, name changes do not require a new application. You can submit a written request along with a copy of the marriage certificate or court order outlining the name change.

Please take some time to review the important points noted here as you are submitting applications for CRICO coverage. This quick reference guide will also be available on the site after the transcript of this video. Now we will go through some select sections of the physician application to answer commonly asked questions.

  1. First, please make sure that you are using the most current physician application. 

    It is important that all applicable fields of the application are completed in full.  Any incomplete applications will be sent back to the credentialing staff member without further review from Underwriting.

  2. Next, we will take a closer look at each section of the application starting with Application Type. This section includes five different options. Please note that multiple application types may be selected.
    • New Applicant – These are new providers that are joining CRICO for the first time.
    • Applicant returning to CRICO – This is a provider that has previously been insured with CRICO.  For example, they completed a residency within the CRICO network, and after completing a fellowship in California, they are returning to CRICO as a staff physician.
    • Specialty Change – This is a provider that is currently insured through CRICO and is requesting a change to their current specialty classification.  Please note that we require a current delineation of privileges in order to make this change.
    • Sponsor/Employer Change – This is a provider that is currently insured through CRICO and will be changing their sponsor and/or employer.  For example, a provider is currently employed as a staff physician through MGH and will be moving to BWH.
    • Employment Status Change – This is a provider that is currently employed by CRICO and will be changing their employment status while remaining under the same sponsor.  For example, a physician changing from fellow to staff.

  3. The next sections we will look at are sponsoring institution, employer, and coverage.
    • The sponsoring institution will be the organization financially responsible for the physician’s coverage.  Please inquire with a member of CRICO’s underwriting team with any questions.
    • Primary employer may be the same as the sponsoring institution or it can be another entity. A CRICO-affiliated entity includes any physician organizations, foundation, or physician practice group that are owned, controlled, or affiliated with the sponsoring institution noted on the application.

      The employer could also be a non-CRICO entity meaning it is unaffiliated with any CRICO member. This is a rare situation and if you believe a physician is employed under this category please inquire with CRICO Underwriting.

    • The effective date provided must be within a reasonable time frame. Requests to backdate coverage must be made in writing and accompanied with an explanation from credentialing to substantiate the need to backdate. Requests will then be reviewed by Underwriting to determine if coverage can be backdated and additional documentation may be required.

  4. Now we will move onto page two of the application. We are going to take a closer look at Licenses and Contact Information on this page.
    • For the License section, be sure to include all states where the physician currently has an active license to practice medicine.
    • The Contact Information section should reflect the physician’s phone and email at the time of employment with the CRICO Sponsoring Institution. A valid email address is required so the physician can access My CRICO

  5. Moving onto page three we will look at both Practice Sites and Telemedicine
    • All practice sites where a physician will be working should be listed and all sites should equal 100% of the physician’s clinical practice. Be sure to only include those sites where the physician will be practicing as of the effective date of the application. Additionally, the listed sites should be affiliated with the employer or sponsoring institution indicated on the application. If not, an explanation is required in writing as to how this physician meets eligibility while working at a non-CRICO site.
    • If a physician has indicated practice of telemedicine at any of the locations listed, they will need to check off the type of service from the selections provided. Depending on what is selected, Underwriting may require additional information.
  6. The next areas we are going to talk about are Specialties and Procedures.
    • First, please indicate whether or not the physician will be practicing as a hospitalist.
    • Credentialing staff should confirm that the physician’s specialty indicated on the application corresponds to their delineation of privileges and procedures performed.
    • If an asterisk is next to a specialty on the CRICO application, a delineation of privileges must be submitted with the application.
    • A few things to note about specialties:
      • A staff physician who is in an obstetric specialty (including family medicine with limited OB) will be rated with the higher-rated premium category regardless of the percentage of time the physician spends in that specialty.
      • All staff physicians with a radiology specialty must complete and attach the Radiology Supplement, which can be found at the end of the Physician Application.
      • House officers and fellows should be placed in the specialty in which best aligns with their training program.
      • Ultimately, Underwriting will use procedures captured on the application, along with Delineation of Privileges documents and any additional information, to determine the appropriate specialty classification for a physician.
      • Placing physicians in the correct class is vital to ensuring equity across all members and incorrect classifications will ultimately result in physicians who are appropriately classed subsidizing those who are not through claims experience and subsequent rate increases.
  7. In the next section there is an abbreviated list of procedures. Physicians should indicate which of these procedures they perform and provide an estimate, where possible, of the number performed annually.
    • The procedure listing is not meant to be all-inclusive. Underwriting may seek additional input from credentialing, the physician, or the physician’s department to aid our review.
  8. Moving onto page 5 we are going to review the Description of Practice and Legal Background questions.
    • In the Description of Practice section, physicians must provide a brief description of their day-to-day clinical practice, using the example provided as a guide.
    • Professional Activities – In this section, please indicate how many hours the physician will be working in a typical week at the time of employment with the CRICO sponsored institution.  Please note that if the hours indicated are less than full time, underwriting may request additional information.
    • Legal Background - For this section, if any disciplinary action is reported on the application, questions 28 must be reviewed and approved by the Chief of Staff and/or Legal Counsel of the sponsor.
  9. Lastly, both the physician and credentialing staff member, department or Chief must sign the application and attest to the accuracy and validity of the information provided on the application.

    Now that we have finished going through the application, we are going to talk about when a claims history is required.  Claims history is only required for staff physicians and not residents or fellows.  A claims history is required in the following situations:
    • Any staff physician applying for CRICO coverage
    • Any physician returning after leaving the CRICO program for more than 3 months.
    • Any staff physician who moves from one Sponsoring Institution to another (for example, from MGH to BIDMC)

      The claim history must be dated within the last 6 months and cover the last 10 years the physician has been practicing.  All claim histories must be on the carrier’s letterhead.

      It is also worth noting that as part of the credentialing process, CRICO requests that any physician entering the CRICO insurance program who previously had a claims-made policy from another insurance carrier obtain the same level of tail coverage from that insurer before entering the CRICO program.

      If there has been any claim activity within the last ten years additional information is required. We request the items listed here but other information may be necessary after Underwriting performs its review. Please note this information is typically satisfied by a combination of documentation and a phone call between an underwriter and the physician.

    Completed applications should be submitted directly to [email protected]. We ask that you, please do not send multiple applications together in the same email as this may delay processing.


September 7, 2018
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