How Credentialing Systems Can Create a Competitive Edge for Payers

In the highly-competitive insurance industry, payers are constantly tasked with finding new ways to differentiate themselves from their competition. An often-overlooked opportunity to stand out among the crowd is the provider data management and the credentialing process.

Credentialing starts during the physician on-boarding process. Recruitment of providers onto payer panels is critical to a payer’s success and presents a unique first-impression opportunity for payers. This is where a payer sets the stage for the physician relationship going forward. A smooth, automated on-boarding process is key to achieving physician satisfaction and creates a positive start to the relationship. Identifying additional ways to add value throughout the credentialing lifecycle is essential to maintaining a mutually beneficial relationship.

For example, collecting information and providing it to a physician, who in turn can pass it along to their patients, improves patient satisfaction, and therefore physician satisfaction. Something as basic as the layout of a building can add significant value to both physicians and patients. Knowledge of which doorway patients must go through or whether a clinic is on the first or second floor is important to patients with limited mobility as it represents ease of access. Payers that are able to track this level of detail, which is then passed onto the patient, differentiate themselves from those payers that can’t track this information. The result is happier physicians and patients.

Unfortunately, because most payers use hospital credentialing systems, which are built specifically to meet hospital credentialing needs, the data tracking and automation capabilities payers need to be successful and compliant aren’t typically available. Those that have turned to home-grown payer-specific credentialing systems are dealing with their own set of problems as these systems are not adaptable nor do they offer true enterprise-wide capabilities.

While it’s been a long time coming, payer-specific enterprise provider data management and credentialing platforms are slowly entering the market. These systems present a unique opportunity for payers to separate themselves from the competition by extending the value they offer.

Meeting Payer-Specific Needs

Vendors have taken what they’ve learned from hospital credentialing systems and incorporated best practices to create highly-customizable credentialing platforms that meet the specific needs of the payer market. These systems are customizable and nimble; enterprise-based and in the cloud, so they can be used by multiple groups in multiple states across the country. Furthermore, improvements in business intelligence, analytics, and advanced reporting ensures that payers can easily report on their data and use that data in actionable ways to improve physician and patient satisfaction. Customized payer platforms also improve efficiency and reduce costs for payers.

It is time payers raise their standards and stop settling for second best. There are many exciting technological advances happening in the payer space. A hospital credentialing system that can’t be customized to a payer’s specific data needs is no longer enough to be successful in today’s competitive payer landscape. Advantages exist for payers that recognize the value in payer-specific platforms. And as technology continues to evolve, the ability to integrate payer credentialing software with contract life cycle management – which has already been done on the hospital side – will further streamline processes.

Read the article in Beckers Healthcare.


Scott Friesen

CEO, Newport Credentialing Solutions.

Service Line: Physician Credentialing

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