Automation and Integration: Doing More with Less

Healthcare lags behind other industries when it comes to automation and integration.

Provider credentialing, privileging, and enrollment are typically manual, paper-based processes. Providers complete and sign hard copies of application forms that must be sent to payers. Checking providers’ enrollment status with insurance companies requires multiple phone calls to the relevant payers. These inefficient processes require more administrative staff and delay provider credentialing and enrollment, resulting in corresponding delays in reimbursement. To improve healthcare [delivery], wmust start moving the needle toward greater automation and integration between software systems.  

Integrating contracting software with credentialingprivileging, and enrollment software is a step in the right direction. Automated workflows increase efficiency by reducing human touchpoints as provider contracts move from initial engagement through signaturecredentialing verification, and submission for enrollment. When the appropriate parties for each step are automatically notified that the provider is ready for their attentionprovider onboarding becomes seamless and more expeditious 

What other ways can healthcare onboarding software providers reduce the administrative burden of credentialing and enrollment and allow health systems to accomplish more with fewer staff? 

Council for Affordable Quality Healthcare (CAQH) Integration. CAQH maintains an online database that stores provider information accessible to health insurance companies during the credentialing process. Providers must attest to the accuracy of their profile every 120 days. If there’s missing data, providers can’t re-attest. Maintaining and updating provider records manually is a time-consuming, cumbersome process. Instead of verifying that the data is accurate, providers may just click “Attest” and submit inaccurate or outdated information. Errors can result in reimbursement problems. Developing an integration between the CAQH database and a health system’s provider management software that allows information to be shared between systems would save time and improve provider data accuracy.  

Integrations with Online Provider Enrollment PortalsA growing number of payers publish a list of providers who participate in their network, but they may not indicate the providers’ locations. Integration between provider management software and provider enrollment portals makes it quick and easy to complete the provider location information.    

Automated Calls for Enrollment Follow-ups. Checking the status of each provider’s enrollment application typically requires phone calls to the payers that involve spending a couple hours waiting in a hold queue. After following up on the status of about five providers during a single call, the health system’s admin staff must call back to check the status of the next list of providers. Health systems need more staff just to handle this inefficient, time-consuming process. One remedy is to automate the calls to payers so that, when the payer finally answers, the call is directed to a staff member who’s waiting to speak with the payer. Staggering the timing of the calls would require fewer staff members able to field more calls.  

By developing these and other integrations and automations, software providers can increase the efficiency of the provider credentialing and enrollment process and help the healthcare industry catch up with other, more-automated industriesThrough these types of process efficiencies, TractManager’s credentialing and enrollment solution reduces standard credentialing process timeframes from 180 to 30 days and enrollments from 90 days to 45 days through a delegated contract. TractManager continues to stay on the cutting edge of technology developments and process improvements, implementing automation and integrations to enhance our clients overall experience, streamline processes, and increase revenues, faster.

To learn more about our credentialing solution, download our “To Delegate or Not to Delegate” white paper.


David Meier

Vice President of Technology, Provider Management

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To Delegate or Not to Delegate – That is the Credentialing Question

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