Many medical, dental, and vision providers can relate – at least to the doing it over again part. Because that’s their experience with provider credentialing.
When providers agree to join a health payer’s network, the office receives a multi-page application that must be filled out first. Once it’s completed, and all the attachments have been added, the provider (or a staff member) must then mail it back – or submit it online if that capability exists. The entire process typically takes 2-3 hours or more to complete beginning to end. That’s a 2-3 hours or more that isn’t being spent on patient-related tasks.
Where it gets tough is what happens next. Just like Tom Cruise, the next time a new application comes in it asks for the same information and the office must repeat the process they just completed. Multiply that for each payer’s network the provider agrees to join and it quickly becomes the stuff of nightmares.
This approach may have been acceptable in the pre-Internet days, when using manual processes for claims processing and benefit management were the only alternatives. But here in the Digital Age, filling out repetitive forms and making endless copies of attachments for each payer network is not the path to greater productivity and higher value care.
The better strategy is to use technology for what it does best – replace repetitive, low-value work with a “one and done” approach. After all, every payer asks for the same information on their provider network applications. Yes, there may be one or two differences from payer to payer, but for the most part the process is just like the Edge of Tomorrow – a pattern that keeps repeating itself.
Using a centralized credentialing service enables providers to enter their information online one time – which they can do in less than 30 minutes. Once it’s there, payers can then download the information on-demand for a nominal fee rather than spending up to $200+ per provider to build their networks.
A centralized credentialing service makes sense on many levels beyond saving time. It eliminates concerns about data errors on credentialing application submissions since providers aren’t required to fill out a new application for each network they want to join. Once the information is correct in the database (helped along by technology that can call attention to incomplete applications or certain errors), it’s correct until something changes on the provider’s end.
If the centralized credentialing service is designed well, it can even remind providers automatically when it’s time to renew license information or re-attest. These reminders to update/renew help ensure the information always remains current.
The net result is providers spend far less time and money working through necessary but repetitive paperwork, leaving them more time to focus on patient care.
Edge of Tomorrow is enjoyable to watch – it’s a great popcorn movie. Living it, however, is far less pleasant.
By replacing manual applications with a technology-enabled solution such as a centralized credentialing service, providers can finally win that battle and move forward with their lives. And their practices.
Mike Lessila is Director of Credentialing Services for SKYGEN USA, a market leader in government programs and commercial plans that is dedicated to transforming the delivery of health benefits through innovative, technology-enabled solutions that help health payers improve efficiency, reduce costs, remain compliant, and manage benefit programs more effectively for providers and members. Mike can be reached at michael.lessila@skygenusa.com.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
