Your provider credentialing process directly affects your organization’s bottom line in numerous ways. It’s worth considering now whether your credentialing function is a headwind or a tailwind on revenue. Here are 3 ways to mind how it affects your business:
#1 — The Accuracy and Usefulness of Your Provider Data
Networks and providers are constantly changing. In fact, key data elements for about 2% of providers become obsolete each month — after just one year, 25% of data is out of date. The typical credentialing system wasn’t designed to keep this data updated, so over time it becomes a repository of outdated data.
What bad data means:
- Compliance risk (and fines!).
- It hinders downstream processes. Incorrect locations and NPIs lead to more claims being rejected or requiring manual review during the claims adjudication process.
- It’s useless for business intelligence.
- Your network adequacy reports will be fuzzy.
How CredSimple is changing the game:
- Guaranteed compliance. Our system automatically matches data against all primary sources and most secondary, backfilling and correcting information that will cause gaps in compliance. Our system also alerts you when credentials expire or any compliance concerns pop up with an individual provider.
- Your data is useful for downstream processes. When key identifiers are correct and match your downstream processes, it makes paying claims and publishing directories a breeze.
- Since your data is accurate, you can download it and use it for business intelligence and network adequacy reporting.
#2 — It Can Be Expensive (and Way too Manual)
With an in-house team:
- How many full-time employees do you have dedicated to data entry, screen scraping, making phone calls, updating spreadsheets and the like?
- This function tends to have high turnover and long training times — which requires a lot of resources and lag time.
CredSimple has automated the data entry process:
- We save your providers’ time. Our digital application takes 20 minutes or we can pull in a provider’s data from CAQH.
- Your employees are free to focus their attention and talent on work that needs human involvement.
- More automation and less human interaction means we can charge less.
#3 — Excruciatingly Long Turnaround Times Prevent Revenue
The status quo (whether you have an in-house team or outsource to any other CVO):
- Turnaround times are often in the 60-to-90-day range, preventing new-provider revenue.
- Manual processes and frequent interruptions to provide status updates or network adequacy reports stretch out the credentialing process for each provider (what’s more, none of this is necessary if you have a software solution that allows this insight!).
- Automated PSV means we can check thousands of providers instantaneously. It doesn’t take us any longer to run PSV checks for 10,000 providers than it does for one provider.
- We average a 5-day turnaround time.
- The status of a provider’s application (or your entire network) are readily available in real time. Providers also receive real-time, direct feedback on their application. If data is missing, they are notified immediately—cutting down delays.
The credentialing process is long overdue for a technology overhaul. CredSimple created the solution to these industry-wide issues. Ask us a question or connect us with your team, and we’ll get the ball rolling.
“… Choosing CredSimple came down to a need for data accuracy and its ability to programmatically record credentialing decisions. To move quickly enough to provide our members with the care they deserve while staying compliant, it’s essential for us to know without a doubt who is credentialed and when, and CredSimple has consistently offered peace of mind with its reliability. – Alicia Beckett, Product Manager, Clover Health