Ongoing Provider Management During COVID-19

Determine which credentialing, privileging, and enrollment actions to take for which provider populations — and when.

Determine which credentialing, privileging, and enrollment actions to take for which provider populations — and when.

Are you ready to recredential, reprivilege, and re-enroll your emergency-staffed providers once the COVID-19 national emergency ends? The Department of Health and Human Services (HHS) renewed the COVID-19 national public health emergency declaration for 90 days, effective Oct. 23, 2020. While the emergency declaration may be extended, hospitals need to start identifying and evaluating the status of providers who have been practicing under temporary privileges and enrollment.

Hospitals responded to the COVID-19 National Emergency Declaration by activating emergency protocols. To ensure care coverage during the pandemic, health plans and hospitals relaxed guidelines and implemented procedures to expedite credentialing, privileging, and enrollment processing times. When you need to onboard providers to meet an immediate need, you can’t afford to wait 90–120 days for the verification of provider credentials required for privileging and enrollment.

Under Emergency Protocol, many providers were granted disaster or emergency privileges—temporary privileges that will be terminated once the situation is under control. In this situation, the privileging process can be completed in 72 hours.

To expedite health plan enrollment, managed care organizations have the option to implement provisional credentialing procedures in compliance with the National Committee for Quality Assurance (NCQA) or Utilization Review Accreditation Commission (URAC). Primary source verification for provisional credentialing requires only three items: a current, valid medical license; five years of malpractice history; and a current signed application and attestation. Under NCQA regulations, provisional credentialing can be used on a one-time basis and is valid for only 60 calendar days. Managed care organizations must ensure that all providers are fully credentialed, reviewed, and approved within that timeframe. URAC does not define a time limit for provisional credentialing.

To ensure that providers are properly privileged and paneled moving forward, organizations need to develop a strategic approach so that all applicable provider populations are identified, captured, and processed in accordance with the permanent governing body regulations.

Identify providers with temporary privileges/enrollment and determine which employment status changes will occur when their temporary privileges/enrollment expire. Temporary providers may:

  • Extend their temporary privileges/enrollment
  • Terminate their employment/enrollment
  • Seek permanent, full-time employment/enrollment
  • Seek privileges at new hospitals within your health system

Depending on the employment status change, you’ll need to take one or more of these actions for each provider:

Determine the critical dates for re-credentialing/privileging/enrollment. When will providers’ provisional credentials and temporary privileges/enrollment expire? Awareness of potential spikes in high-volume months will identify when potential help is needed to ensure timely file processing

Fully credential providers who were provisionally credentialed. You will need to rework those credentialing files, requesting/gathering all credentialing documentation and conducting extensive primary source verification in compliance with organizational bylaws

Reprivilege and/or re-enroll providers in accordance with federal, state, and governing body regulations. Centralize and automate the review process for key stakeholders to ensure no lapse in coverage or enrollment occurs

Terminate privileges and/or enrollment. If you have a delegated agreement with health plans, you can submit multiple enrollment terminations on one roster, along with new enrollment applications and changes to existing providers. In a non-delegated environment, paper processing will require time and effort to ensure clean directory representation

Update CAQH profiles. Providers must update their information in the CAQH Provider Directory when they terminate their employment or have a change in dynamic data. Providers and health plans must review and update provider information regularly to meet federal and state requirements for maintaining the accuracy of provider directories

Ensuring that hundreds of providers (each enrolled in multiple health plans with different requirements) stay properly credentialed, privileged, and enrolled is a cumbersome, time-consuming task.

TractManager’s credentialing and enrollment experts deliver ongoing provider management services, quickly and compliantly re-credentialing/privileging/enrolling providers and updating provider directories. Our automated CAQH integration handles massive profile updates with one click. To learn more about our solutions, 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.

 

Related Blogs:

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.

Share This