Healthcare Credentialing News & Insights

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. […]

Why is Jessica so Frustrated? Jessica is a busy credentialing coordinator who has been in her role for 5 years. Today, she arrives at her desk to voicemails and emails from the provider relations department requesting status updates on credentialing for their new providers. By lunchtime, she has received more status requests. Every time she […]

Hospital recredentialing tip

With so many moving parts, hospitals — or any other clinical care organizations that employ or work with healthcare providers — must decrease any roadblocks to compliance and revenue cycles. Improving recredentialing efficiency is one way to do so. Cut Out Redundant Affiliation and Privileges Checks When it comes time to recredential providers, organizations can cut […]

We work with a number of health plans and we’ve learned a few tricks that can help reduce provider credentialing turnaround time. Reduced turnaround times increase provider goodwill, help operations improve revenue cycles, and ensure your members have access to the providers they need. The changes include increasing the efficiency of the approval process for […]

Provider credentialing is a necessary business function for health plans and is required in order to ensure quality of care for members. When implementing — or reevaluating —  a credentialing process, there are a few important factors to consider such as cost, employee time and even whether to adhere to NCQA or URAC standards. A […]

The accuracy of provider data starts with credentialing and affects downstream functions and business intelligence. Today most healthcare companies are not able to maximize the value of the credentialing process because the technology underlying the process was not designed for the data needs of the 21st century. Understanding the root of the problem and the […]

In this series, we break down what you need to know about NCQA’s credentialing requirements. Here we’ll cover NCQA credentialing requirements 4 – 8, which ensure that credentialing committees are reviewing all the necessary information about a provider’s credentials and work history so that the committee can make a well-informed decision. In prior posts, we […]

clover_health_disruptor

Disruption is happening in every industry these days. To be hailed a “disrupter,” a company must challenge the status quo. One way to do that is to question industry assumptions. It takes a bold and forward-thinking company to take on entrenched “we’ve always done it this way” practices, especially in a highly regulated industry like […]

Reduce Credentialing Turnaround Time

If you’re constantly playing catch up when it comes to provider credentialing turnaround time, you’re not alone. For most health plans it takes 60 – 90 days to complete provider credentialing. This lengthy waiting period directly impacts cost and turnaround time. The good news is, that’s no longer necessary. Learn how you can: Eliminate redundant […]

Provider directories are an important resource for network management and referral management. They are also an important tool for healthcare consumers. Provider directories are one of the first, and most important, gateways in a consumer’s healthcare journey. For all these reasons, we wanted to know more about what healthcare consumers think about provider directories. So […]