Provider Privileging: Why Integration with Credentialing and Enrollment Is Important

Integrating provider privileging with credentialing and enrollment processes streamlines and accelerates provider onboarding and improves provider satisfaction.

Provider privileging—the process of authorizing a specific scope of practice for patient care based on an evaluation of a provider’s credentials and performance—is essential for appropriate care access, quality governance and risk management, and patient safety. Providers are granted privileges to perform a specific service or procedure, or to treat a certain condition at a specified healthcare facility such as a hospital or an ambulatory surgery center. A provider who is not properly privileged at your healthcare facility cannot see patients there.

Like the credentialing process that precedes it, the provider privileging process is complex, labor-intensive, and time-consuming—for providers and medical staff personnel. Provider privileging can take up to 60 to 90 days, assuming no delays in verifying credentials. In some cases, credentialing and privileging happens before a single enrollment application is submitted to health plans. Certain health plans require that providers have appropriate hospital privileges in place prior to enrollment. If providers do not have adequate coverage or admitting arrangements, they will not be enrolled with the health plan.

Privileging is a mission-critical step in the process that has direct implications on revenue for a health system. Delays in provider privileging are associated with lost revenue. You’re paying employed providers a salary before they can see patients and bill for services. Providers cannot bill health plans for reimbursement until the providers are participating in that plan’s network. As a result, provider enrollment delays cause reimbursement to be delayed or written off. Consequently, employed providers are an expense for your organization every day they are not onboarded.

RELATED GUIDE: The 4 Ds of Provider Onboarding Guide

Integrating provider privileging with credentialing and enrollment processes streamlines and accelerates provider onboarding, reducing the administrative burden for medical staff personnel and providers, and improving provider satisfaction.

Benefits of Integrating Provider Privileging with Credentialing and Enrollment

Faster, more efficient provider onboarding. Privileging timelines depend on the accuracy and completeness of the credentialing documentation provided. Starting with credentialing data that has already been verified during the credentialing process speeds up privileging. When credentialing, privileging, and enrollment processes are integrated in one central software system with automated workflow, triggers automatically kick off the next step in the onboarding process.

Avoid duplication of work. After providers submit the privileging request application, the medical staff office verifies their credentials and conducts background and reference checks. Typically in a health system this is completed across multiple facilities, repeating a step that was already completed during credentialing. When credentialing and privileging processes are integrated and share credentials verification data, you eliminate that repetition and reduce the associated administrative costs and burden.

Increase provider satisfaction. Inefficient credentialing, privileging, and enrollment processes and non-standard forms frustrate providers, who spend too much time completing paperwork and submitting the same information multiple times. Digital credentialing, privileging, and enrollment applications simplify the application process, and real-time provider data stored in a single, central database eliminates repeated requests for the same information. Providers are often frustrated when they cannot begin seeing patients on their start date. Faster onboarding means happier providers and happier patients, who have better access to providers.

Eliminate functional silos and systems. For any organization with multiple facilities, it is imperative to consolidate to an integrated platform that aligns all provider onboarding requirements of contracting, credentialing, privileging, and enrollment. This increases transparency and collaboration across multiple departments.

TractManager’s Provider Privileging solution is integrated with our Credentialing and Enrollment solutions, allowing you to easily manage the entire provider onboarding process with our state-of-the-art CARE software. CARE centralizes credentialing, privileging, and enrollment functionalities across multiple facilities within a health system. To learn more about TractManager’s Provider Privileging and Provider Onboarding solutions, watch our webinar, Accelerated Provider Onboarding: Bring Providers and Patients Together — Faster.

Author:

Anna Arutyunyan

Vice President, CVO, Provider Management

Anna has extensive experience in the development and implementation of full-scope credentialing programs.

 

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