Provider enrollment has become increasingly complex. Changes in reimbursement, narrow networks, and risk based contracts have created a new provider enrollment landscape which has left many administrators and providers scratching their heads for answers. For a small provider group, running the credentialing and enrollment process in-house is a manageable endeavor. However for hospitals and health systems, especially thosewith multiple locations, it can be a time-consuming and costly endeavor. This is especially true when relying on manual methods like paper documentation and email calendar alerts to runcredentialing in-house.
With the financial implications of not properly managing credentialing and enrollment well known, more and more providers are turning to outsourced partners for help. With the right partner, outsourcing is a much easier and cost-effective option to managing the process in-house.
To help administrators and providers find a partner to best fit their needs, consider the following:
Experience matters. A vendor partner that is highly trained and skilled in credentialing and provider enrollment means less worry for yourorganization. Ensure that the partner you select has an in-depth knowledge of credentialing and provider enrollment. For example, your vendor partner should have a deep understanding of state-specific payers and the best ways to maximize the processing of your applications. Further, the vendor should have established relationships with payers so that they know who to call when follow-up is needed.
Pick a partner. When selecting a vendor, remember that you are also choosing a partner. Don't make your partner decision after one brief presentation. Take the time to meet face-to-face with the prospective partner(s) before you make your selection. It is important that you understand the personalities and how they work. Communication and a good working relationship are essential for a successful partnership.
One size does not fit all. Because every organizationis unique, it is important that the vendor you select is flexible and can offer a customized approach for your organization and providers. Look for a vendor that takes the time to understand the workflow of your practice and will work with you to meet your specific needs.
Technology matters. Beware of legacy credentialing software applications that rely on an outdated technology. Even with the best people in place, if the vendor doesn’t have the right software systemto manage the credentialing process, success will be difficult to achieve. Cloud-based systems offer better user analytics and provide “portals” that support data entry and retrieval access to various stakeholders in the credentialing lifecycle.
Reporting and analytics is key. Make sure the vendor you select offers value-add, easy to use reporting capabilities to demonstrate their progress. Ideally, reports should be available online so that they can be accessed 24/7. If online access is not available, ensure the vendor is able to provide you with these reports on a weekly basis. Standard Key Performance Indicators (KPIs) should be used to drive vendor accountability.
Don’t base your decision on cost alone. When considering a vendor partner, it is easy to be swayed by a low price tag. However, when it comes to outsourcing, the adage “you get what you pay for” is often true.
With the necessary due diligence and the right partner, a well-managed credentialing process can be easily developed.