Automated Primary Source Verification

Primary source verification is the meat of the credentialing process and because it has traditionally been based on time-intensive manual work and tedious data entry, it has been a resource-intensive and delay-inducing process.

Why is Primary Source Verification so important to health plans and telehealth and behavioral health organizations?

Your provider network is a major part of the member and patient experience and, therefore, brand. Its quality and adequacy determines their happiness and health. It affects how they think and talk about your brand.

Your network also affects revenue. Revenue can be affected by benched providers (because of initial credentialing delays or due to a recredentialing backlog) or, for new networks, by extended network spin-up timelines or network adequacy issues.

And once a provider is credentialed, regularly monitoring DEA, sanctions, malpractice and state license data, as well as medicare opt-out, is key to staying on top of your network in order to make proactive decisions about providers as issues arise.

The current Primary Source Verification paradigm is inefficient and resource intensive. But it doesn’t need to be.

Whether you’re doing this in-house or using a legacy CVO to conduct your PSV work, this process is heavily dependent on people performing time-consuming manual tasks and repetitive data entry.

Familiar Credentialing Pain Points

People-Driven Process
Compliance and
Network Risk
Unnecessary Costs
Employee Overload

What does the legacy way of primary source verification mean for your staff?

  • Lengthy turnaround times: the average industry credentialing turnaround time is 60+ days.
  • Low volume of credentialing output
  • Backlogs
  • Employee overload and dissatisfaction
  • Being forced to prioritize manual PSV work over provider relations or more strategic products

What does it mean for your bottom line?

  • Data entry errors that can affect downstream processes or lead to CMS fines
  • Replacing, hiring and training due to staff turnover or seasonal hiring is expensive

“It’s a total collaboration between CredSimple and us. We are a team. A lot of times, you pay for a service and that’s as far as it goes. There’s no open dialogue. CredSimple goes above and beyond in assisting with improving our credentialing program.”

Rebecca, Credentialing Specialist, VGH

Why does fast, accurate, efficient primary source verification matter?

Every day a provider is not credentialed matters to your members and your bottom line. When you are able to both quickly credential providers and stay on top of your already-credentialed providers you’ll avoid preventable costs, protect members, and ensure network adequacy.

 

How has CredSimple improved primary source verification in order to achieve an average 5-day turnaround (on 1000s of providers)?

CredSimple’s CVO services run on sophisticated technology that automates the monotonous primary source verification work required for compliant credentialing and simplifies everything else: the application, committee review prep, approval, ongoing monitoring, recredentialing and reporting.

This is how we transform the credentialing function into a fast, compliant and cost-effective process for healthcare organizations who are dissatisfied with inefficiencies that lead to burned out employees, dissatisfied providers and missed business opportunities.

Because we’ve automated this process, our primary source verification is automated and concurrent. This prevents unnecessary and delay-inducing re-work. We can credential 1000s of providers in an average of 5 days (for providers with compliant applications).

No more looking up each primary source individually and manually. No more screen scraping. Instead, you’ll have usable, accessible data.

This only improves your bottom line because the provider data obtained during the credentialing process won’t include typos from manual data entry. This means it’s accurate and,  therefore, useful to downstream processes such as your claims process and your provider directory.

It also improves your bottom line and allows you to provide the optimal deployment of your people resources. Removing tedious manual work means your credentialing team can focus on work that requires a human (and that brings them higher satisfaction) such as provider relations or time to work on strategic projects. And you won’t need to add extra headcount to help with work your team hasn’t yet able to focus on.

Your team can be done by 5:00 pm, even during a busy open enrollment season. And you’ll decrease costs typically associated with manual work, including overtime, seasonal hiring and turnover, which itself leads to more hiring and training costs and resourcing.

See how CredSimple optimizes your credentialing process, increasing efficiency & speed.

Increase Your Operational Efficiency in No Time

Our CVO services utilize a cloud-based, secure website, so your IT team doesn’t need to be involved in any software setup or configuration.

They’ll just need to spend about 20 minutes exporting your historical credentialing data en masse.

Your team will be able to use CredSimple in no time, as we’ve built it to be user friendly. Training takes a just few hours because we’ve built our interface to be intuitive and easy to use. And more importantly, your dedicated client success manager will ensure success at the get-go as well as ongoing. Our clients choose not only for our sophisticated technology but also for the partnership mindset we bring to the table.