Efficiency at First Sight: When Contracting Met Provider Management

Integrating provider contracting and credentialing accelerates onboarding.
Integrating provider contracting and credentialing accelerates onboarding.

As Shakespeare famously wrote, “The course of true love never did run smooth.” In order to develop and maintain any successful relationship, challenges must be faced, difficulties must be overcome, and goals must be aligned to achieve the fabled “Happily Ever After.” Whether personal or professional in nature, relationships are built on a foundation that includes several important characteristics: compatibility, flexibility, and effective communication.

Healthcare contracting and credentialing teams share a common purpose: onboarding providers quickly so they can start seeing patients and getting reimbursed right away. Healthcare organizations face serious legal, financial, and compliance risks if providers are granted access to health plan members before their credentials are verified, reviewed, and approved. Essentially, blind dates don’t go over well in the healthcare world: providers must be credentialed prior to full contract execution and enrolled with health plans prior to their start dates.

When provider contracting, credentialing, privileging, and enrollment are conducted separately, without communication or sharing data between departments, the entire process—from recruitment to enrollment—can take up to 245 days. Delays in onboarding are costly: on average, physicians bill $6,250 per day—whether or not their claims are eligible for reimbursement.

RELATED EBOOK: The Invisible Impact of Credentialing and Payer Enrollment

To accelerate the onboarding process and manage legal, financial, and compliance risks, an effective, integrated provider onboarding process across multiple departments—including contracting, credentialing, privileging, and enrollment—is essential. Balancing these relationships requires a lot of skill and care, and the output of this effort is measurable by decreases in both overall processing times and bad debt/lost revenue.

The integration between compatible provider contracting and onboarding software improves quality and speeds up onboarding via:

Sharing common interests (clean data). When provider data comes from multiple sources and is entered several times into separate systems, you may wind up with inaccurate data, which is then submitted to health plans for enrollment. You must have current, clean data to maintain accurate provider directories and comply with CMS and other governing bodies and regulations. 

Storing real-time provider data and documentation in a single, centralized database improves data quality, access, and transparency, and eliminates duplicative requests for information, reducing provider frustration and associated administrative costs and burdens. This is where your processes can go from love at first sight to a true relationship. You can share clean data that has been suitably vetted in a timely manner to the health plans and across your organization without further delay.

Flexibility. When your provider contracting and onboarding software is customizable to meet your organization’s unique needs, you’ll work more efficiently. Healthcare rules and regulations are constantly evolving, and technology and service offerings need to be flexible enough to maintain the proper execution of workflow channels. New mergers/acquisitions come with new rules and regulations and need to fit seamlessly into the program. You should be able to customize your workflows, provider profiles, and reporting without manual intervention or delay. When your software can adjust where needed, your contracting and credentialing are well on their way to a healthy, happy life together!

Effective communication. When your contracting software and provider management software effectively communicate with one another, workflow triggers automate the next step in the process, such as initiating credentialing or finalizing the contract. When data is validated at the source, changes in provider credentialing and enrollment status can be fed back into contract management workflows and reports, allowing real-time review and corrections. This speeds up the process by avoiding manual handoffs and back-and-forth emails between your various departments and divisions. Open and effective communication helps you to be fully connected in your relationship.

MediTract CLM, TractManager’s Contract Lifecycle Management software, and CARE, our Credentialing, Privileging and Enrollment software, work together to coordinate and streamline the tasks required to complete the onboarding process. By thoughtfully integrating provider contracting, privileging, and enrollment processes, our provider onboarding solution reduces onboarding timeframes from 245 days to 115 days. Now that’s a partnership heading toward its Happily Ever After! To learn more, read the white paper The 4Ds of Provider Onboarding Guide.

Author:

Allyson Schiff

Senior Director, Strategy & Growth, Provider Management

Allyson Schiff joined Newport Credentialing Solutions in 2009 and joined TractManager when Newport was acquired in 2018.

 

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Related Resources:

The 4 Ds of Provider Onboarding Guide

Understand the Impact of Provider Onboarding:
This guide discusses the 4 Ds of a successful provider onboarding program and offers action steps to improve a healthcare organization’s financial wellness.

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