WHITE PAPER. Taking the Groundhog Day Out of Credentialing. Using technology to bring healthcare provider credentialing into the Digital Age

Transcription

1 Taking the Groundhog Day Out of Credentialing Using technology to bring healthcare provider credentialing into the Digital Age JULY, SKYGEN USA Page 1

2 For most healthcare providers, the credentialing process must feel like the movie Groundhog Day. And they are Bill Murray. The office receives a multiple-page application that must be filled out in order to add the provider to the payer s network. The provider or a staff member then dutifully fills out the application, attaches appropriate items, and mails it back or (in the more progressive instances) submits it online. Next week, another application comes in asking for the exact same information and the office goes through the process again. Rinse and repeat to become credentialed in each payer s network. That system might have been acceptable in the past, when claims processing and benefit management were manual, offline processes. But in the Digital Age, when we can pay for many items by waving our phones at a reader, and our cars are almost ready to drive themselves, submitting provider credentialing applications one payer at a time, and then repeating the process year after year, seems rather anachronistic. Think about the process you go through to look for a new car. If you have your eye on a particular make and model and want to learn which car dealers in your area have it on the lot, and at what price, you don t have to visit each dealer in person, or even contact each dealer individually. Wouldn t it make more sense for the industry to use a centralized credentialing website where dentists enter their information once, keep it up to date as things change, and then payers subscribe to the information on-demand? Instead, you can simply fill out a single online form, and 20 minutes or so later your box will explode and your phone will be ringing incessantly with dealer calls. It s simple and convenient, requiring minimal effort on your part to receive the maximum benefit. When it comes to credentialing, the reality is every payer asks for the same basic information. Sure, there may be one or two specific items to a particular payer, but for the most part filling out the application is just like Groundhog Day SKYGEN USA Page 2

3 Needlessly tedious With a paper-based application, there is no easy away around the tedious work. Someone must complete each section in every application one at a time. Sure, you can make a copy of the previous application so most of the information is readily available, but it still must be copied over by hand like medieval monks making copies of the Bible and other historically important documents. Only without the detailed illustrations. Online applications in use today don t fare much better. They typically are very confusing to use (i.e., have not had much thought put into them) or ask the healthcare providers in one specialty, such as dentists, to complete the same applications designed for use by other healthcare professionals, such as M.D.s or ophthalmologists. This one-application-fits-all approach creates lengthy documentation that forces everyone to read through questions and requests that have absolutely nothing to do with their specialties. This approach is not only confusing, it actually defeats the purpose of using an online solution. In the Digital Age, trying to be all things to all people is a very tough task, and it usually does not work very well. Instead, it makes far more sense to use a centralized resource where healthcare providers enter their credentialing information once, and then just update their profile as things change. That information is then available for payers to subscribe to on-demand, any time they need it. Centralized credentialing service saves money and time The benefits of using a secure, centralized credentialing service are many. Instead of taking 2-3 hours to fill out each application with demographic information, National Provider Identifier, licensure data, etc., and to make copies of attachments and mail them all (multiplied by the number of payer networks the provider wishes to join), the entire data entry process can be completed online once in less than 30 minutes. If necessary information is missing, the system can prompt the provider to include it to prevent delays in approval. Here s how it works: 2017 SKYGEN USA Page 3

4 (continued) In multi-provider offices, a single office manager or other employee could upload the credentialing information for the entire practice at once, saving even more time. When it s time to renew license information or re-attest, the centralized credentialing service sends reminders to providers, ensuring their information is always current. The time providers save by using a centralized credentialing service can then be dedicated to serving patients, or even working fewer hours. Payers save significant time and money as well, by eliminating the need to mail applications and then follow up constantly to build their networks a process that typically takes weeks or months and costs up to $200 or more. Instead, they could obtain the information on-demand for less than $10 per unverified provider application. Speeding up this process will also enable providers to become part of the network faster, which lets payers launch their networks sooner, because payers wouldn t have to wait for applications to be filled out and returned, and wouldn t have to go back for missing information. The result is that members have more complete access to quality healthcare in a timely manner. Finally, using a centralized credentialing service eliminates the issue of data errors on submissions since providers are not filling out a new application each time. Once it s correct in the database, it s correct until something changes on the provider s end. Break the endless credentialing loop Groundhog Day is a fun movie to watch. But it s not so much fun to live it. Fortunately, a technology-enabled solution is now available to move provider credentialing into the Digital Age. FOR MORE INFORMATION, CONTACT: Lance Stewart Chief Growth Officer P: E: Lance.Stewart@SKYGENUSA.com Visit our website: SKYGEN USA Page 4

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