Why should you outsource your credentialing to a CVO? And what should you expect?

Provider credentialingrequired for all hospital privileging and managed care payer enrollments — is a heavily regulated process that can take up to six months to complete. Credentialing includes the verification of specific elements (e.g., medical license, board certification) against primary sources, the review of findings against legal and regulatory standards, and approval by a board of peers.

Incomplete or inaccurate information regarding a provider’s credentials can result in extensive and expensive delays. Credentialing delays are costly — in terms of postponed reimbursements, reduced member access, and frustrated providers.

There is significant risk associated with provider credentialing. Improper credentialing can directly impact patient safety. Failures of credentialing have been linked to large malpractice suits, some of which set the legal precedents for today’s credentialing laws and regulations. Variations in regulations between state, Federal, and accrediting bodies further complicate an already complex process.

To complete the credentialing process quickly, accurately, and compliantly, healthcare organizations should explore options to outsource credentialing to experts. Credentials Verification Organizations (CVOs) perform medical credentialing on behalf of a healthcare organization, verifying providers’ documents for the organization.

Why should you outsource your credentialing to a CVO?

CVOs provide full-scope credentialing services to help your healthcare organization:

  • Streamline and automate credentialing processes.
  • Onboard providers faster so they can see patients and get reimbursed sooner.
  • Minimize financial risk by reducing the likelihood of noncompliance, inaccuracy, and increased audits that drain financial resources.
  • Significantly reduce credentialing-related claims issues (e.g., edits and denials).
  • Improve provider and patient satisfaction.

What should you expect from your CVO?

  • Expertise
  • Compliance
  • Quality
  • Value
  • Timeliness

Look for an organization that is accredited in credentialing by the National Committee for Quality Assurance (NCQA). CVOs that are NCQA Accredited in Credentialing handle the entire credentialing process and have gone through extensive evaluations, quality audits, and reviews — the same standards to which a healthcare organization is held by the accrediting bodies. Our comprehensive CVO solution reviews credentialing applications for accuracy; conducts Primary Source Verification (PSV); prepares credentialing files for review by the credentialing peer review committee (CPRC); schedules and hosts the CPRC meetings and records the decisions; generates and sends provider notification letters; performs ongoing monitoring of provider performance; tracks expiration dates for credentials; and handles re-credentialing at the appropriate time.

TractManager is NCQA Accredited in Credentialing. TractManager’s Provider Credentialing reduces the credentialing process time from 180 to 30 days. We are a true one-stop shop — a long-term operational partner you can trust, with expertise you can count on.

For more information, download our “To Delegate or Not to Delegate – That is the Credentialing Question” white paper.

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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