Better Together: Integrating Credentialing and Contract Lifecycle Management

In an industry as heavily regulated as healthcare, contracting takes on new importance. Here, compliance concerns mean that definitions of value must also encompass the potential regulatory penalties a health system must avoid. And within the context of compliance, process matters as much as output and has implications for everything from concerns about cybersecurity to physician satisfaction.

Consequently, effective healthcare contract management solutions must also support, enforce, and report on multiple compliance, financial, or risk-related processes, all while integrating with ERP and credentialing systems to ensure the presence of any required documentation, attestations, or licensures.

In particular, credentialing workflows represent a key store of hidden value. Legacy (that is, largely manual) processes can cause delays that prolong provider onboarding, credentialing, and enrollment. A typical onboarding can take up to 180 days to complete. This timeline can adversely affect provider satisfaction, care delivery, and network growth, as well as increase compliance risks, compromise brand integrity, and negatively impact revenue cycle management.

To compound this further, organizations can face serious legal, financial, and compliance risks if providers are granted access to members prior to credentials being verified, reviewed, and approved.  This means ensuring that providers have been credentialed prior to full contract execution and enrolled with the payers prior to their start dates. Properly managing these risks requires developing an integrated provider onboarding process across multiple departments, including network relations, contracting, credentialing, and enrollment—a feat difficult to accomplish with legacy systems that exist in silos.

While providers have a vested interest in making certain that their contractual relationships are being appropriately managed, most believe that it’s not their job, which means the onus falls upon the health system. Any delays in onboarding can result in a significant financial impact: on average, a physician bills $6,250 per day—whether or not the provider’s claims are eligible for reimbursement.

Healthcare-specific contract management systems and processes can mitigate all these risks, assuming they offer integration with credentialing and payer enrollment. The ideal solution centralizes the critical stakeholders in a single platform; offers full contract management, credentialing, and enrollment functionality; is customizable to meet the unique needs of each healthcare organization; and is intelligently designed to daylight potential gaps in compliance and highlight potential bad debt.

Such close integration eliminates weeks or even months of delay, allowing health systems to recognize more revenue, faster. Moreover, because data is validated at the source, changes in provider credentialing and enrollment status can be fed back into contract management workflows and reports for real-time review and remediation. Such real-time integration of contracting, provider credentialing, and enrollment workflows supports:

  • Faster provider contracting and on-boarding.
  • Increased access and capacity and improved care delivery.
  • Increased provider and patient satisfaction.
  • Legal, compliance, and financial risk mitigation.
  • Single source of truth, process centralization, and scalability.

In summary, with methodical processes in place for centralizing, standardizing, and optimizing data, plus configurable, automated workflows and advanced analytics, health systems can reduce exposure to risk while enhancing the ability to uncover valuable insights from their contract assets—intelligence capable of answering key business questions health systems might not even be asking.

At least not yet.

Interested in learning more about optimizing the value of your compliance efforts? Register for the End-to-End Physician Management with MediTract webinar.

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