Ask These 7 Questions To Integrate Credentialing and Enrollment Blog Feature

By: symplr on December 2nd, 2020

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Ask These 7 Questions To Integrate Credentialing and Enrollment

Credentialing Software | Payer enrollment management

Integration is occurring in all facets of healthcare, but we’re focused on a topic close to home: Integrating provider credentialing and payer enrollment (PE) functions. Ask practical questions to eliminate redundancies and share information, regardless of what resources you have, and in spite of what seems like an enormous task.

Redundancy in provider data management tasks doesn’t just lead to higher operational costs or a longer timeline for reimbursement. It also contributes to provider dissatisfaction and could render your organization unable to delegate with a payer. As a provider data management professional, you have the power to help rein in costs, cultivate buy-in to new interdepartmental procedures, and improve provider satisfaction.

Healthcare leaders see synergy—but also costly repetition—in these touchpoints with providers:

  • Recruiting, onboarding, and orientation
  • Enrollment and credentialing
  • Privileging and reappointment
  • Quality and performance improvement
  • Revenue cycle/coding

To pinpoint inefficiency in your provider data management processes, look for duplicate requests of providers for the same data or multiple instances of outreach from different functions/departments. Eliminate  extra steps that don’t contribute to the end goal of gathering data and entering it once into a comprehensive platform

Start asking the right questions

Use these seven questions to start discussions about eliminating redundancy and, ultimately, achieving integration:

  1. What departments or functions are involved in recruiting, onboarding, credentialing, and enrollment at your organization?
    • Examples might include: An internal or external credentialing verification organization (CVO), the medical staff services department, the enrollment function, billing, human resources, physician liaisons, and the quality department.
  2. What internal and external software is used to gather and manage provider-specific information?
    • Examples can be wide ranging, including: Vendor credentialing software, EHR/medical billing software, CAQH, PECOS, online integrated applications from a state or other source, or a CVO or other delegate’s software.
  3. With what other departments or functions involved in provider data management at your organizations is sharing data appropriate?
    • What specific data must be kept in-department, confidential, or otherwise inaccessible and why?
    • If data can be shared among the other departments/functions, is sharing a database or sharing screens an option in your current state? Why or why not?
  4. In comparing provider data-related administrative tasks associated with onboarding, enrollment, and credentialing—what items are duplicated?
    • For example, these may include general data, documents, attestations, references, interviews done cross-departmentally, licensure checks, background checks, fraud screens, and insurance coverage checks.
  5. At what stage of getting a provider onboarded and set up to see patients do the duplicate (or triplicate!) checks from the previous question occur?
  6. Is there a valid reason for the double- or triple occurrences of data requests or external checks?
    • Identify whether the data initially gathered might change over the time from onboarding to privileging, rendering the update necessary (for example, insurance coverage verification from initial onboarding to reappointment).
  7. Would the integrated function:
    • Improve data transparency, accountability, and integrity? How?
    • Foster better communication between departments and team members? How?
    • Decrease time to onboard, credential, or delineate privileges? How?
    • Improve customer (read: provider) satisfaction rates? How?
    • Speed time to reimbursement? How?

Calculate what silos really cost

Organizations that have tried to align credentialing and enrollment, but haven’t succeeded, find hurdles in the form of:

  • Paper processes
  • Internal policies/conflicts over data ownership
  • Insufficient resources
  • Communication gaps, and other challenges  

Using a single lifecycle practitioner database provides a significant head start in integrating functions to streamline operational efficiency. Improved decision making that results from better data management and analytics can make the difference in when operating margins are razor thin. 

Software as a service (SaaS) eliminates the large upfront costs usually associated with a new platform. Without the need for a capital expense request, budgeting is simpler and more predictable. SaaS also easily integrates with other systems (both SaaS and on-premise hosted), and creates the uniform platform needed to share and move provider data seamlessly across all tasks in the healthcare governance, risk, and compliance (GRC) space, which saves additional labor costs and time beyond credentialing and PE.

Integration efforts start with due diligence and end with eliminating redundancies for the benefit of the organization, providers, and patients. What’s the true value of a simplified, integrated, end-to-end provider data management process to your healthcare organization?

Learn how symplr eliminates redundancies.



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