No matter what type of healthcare facility you work in, hiring a credentialing verification organization (CVO) is a tried-and-true way to achieve fast, accurate medical provider credentialing and payer enrollment. Organizations of all sizes use CVO credentialing to handle rapid growth and busy times, increase customer satisfaction, and better manage resource capacity.
CVOs exist to help healthcare organizations verify licensed medical practitioners’ qualifications (i.e., credential) and enroll them into payers' health plans, in order for the provider organization to be reimbursed for services. CVOs do so by accepting delegated responsibility to gather information on clinicians’ backgrounds, identify gaps or red flags in large volumes of data, and report the findings. They don’t typically make credentialing decisions on behalf of your organization, unless that role is specified in your contract.
How CVO credentialing ensures overall organizational health
Every credentialing department is asked by its administration: “How long will it take to credential and enroll this provider?” Unfortunately, at many organizations, the answer is, “too long.” It’s no understatement that an efficient credentialing service contributes positively to the overall fiscal health of any healthcare organization. The costly consequences of credentialing and enrollment disorganization can include:
- File backlogs
- Unfilled clinical positions
- Lost revenue
- Dissatisfied providers
- Inconvenienced patients
Yet, while many organizations have well-established account billing processes, their credentialing and enrollment procedures are not optimized. For example, delays result from staff inexperience in identifying designated equivalent sources and navigating resources and standards (e.g., The Joint Commission and the National Association for Healthcare Quality).
In addition, manual processes abound, creating unacceptable timelines for onboarding or payment. It can be difficult to source and retain qualified credentialing professionals, creating gaps in file continuity. The CVO medical process is a simple remedy for all of these challenges. Further, a qualified CVO will lend expertise and technology, if needed.
CVOs solve the build-or-buy dilemma
Medical credentialing and payer enrollment are demanding and time-consuming tasks. Like businesses in other industries, healthcare facilities come to a point where they must make a decision to “build or buy” for executing on credentialing-related tasks. That is, do they expend the resources required to establish a fully functioning CVO that can:
- Handle growth
- Keep the organization in compliance
- Ensure provider quality and patient safety
And all of this must be done on top of servicing the other daily associated with provider management. Outsourcing to a qualified credentialing verification organization makes vetting providers easier. Done well, the contract process with a CVO is simple, fast, and tailored to an organization’s needs from all perspectives: budgetary, scheduling, duration, and scope.
Specifically, a full-service, NCQA-certified credentials verification organization will be capable of supplementing your team as needed, or fully take over delegated responsibility for specific activities identified in a CVO contract. Responsibilities may include:
- Credentialing/primary source verification
- Payer/provider enrollment
- Licensure application and sanctions monitoring
- Background screening
- Policy and procedure consulting
- And more
How to hire a CVO, in 5 steps
What’s involved in hiring a CVO to get your organization on its way to achieving fast, accurate, credentialing and enrollment? First, dismiss any notion that your organization is too small or specialized to contract for the CVO process. A qualified CVO will address your organization’s individual needs, understand your state licensure rules, and create a custom solution that ensures satisfaction among your internal and external customers (e.g., payers, patients, providers, or administrators).
Here’s the typical process symplr CVO customers experience:1. Notify symplr of your need for primary source verification, credentialing, licensure application, provider/payer enrollment assistance, or any other unique need for credentialing support.
2. We put you in touch, from the first call, with our experts to listen to and understand your organization’s unique needs.
3. Only then will we create a customized proposal based on your needs, budget, staff, and the technology already in use at your organization.
4. Upon agreement, we’ll go to work immediately—often in hours or days—managing your processes and showing you multiple options for remaining updated on credentialing, licensure, and enrollment status.
5. When you're quickly caught up, we can adjust to serve as a resource on standby, or continue with ongoing help as your needs fluctuate.
Best of all, symplr CVO charges a flat rate per application, and keeps working at a file regardless of how long it takes, or how many instances of follow up (e.g., phone calls, databank checks, emails, letters, etc.) are required with a practitioner, provider organization, or payer. Once work begins with a CVO like symplr CVO, you should pay once per application. Your price per application should stay the same, so you can easily plan your costs whenever you onboard a new practitioner, or need to renew your applications.
Beyond basics: Specialized CVO expertise
Backlogs of claims on hold, pending applications containing errors, licensure for providers practicing telemedicine across state lines. Every healthcare organization that pursues the help of a CVO has different needs. But a qualified CVO can fill any gap from credentialing to state licensure services.
Claims on hold, for example, is a common yet costly problem that a CVO can help remedy. For provider organizations, physician insurance enrollment can be slow and unnecessarily complex. Provider organizations simply want their practitioners to be able to start treating patients. It doesn’t take long, unfortunately, for millions of dollars in backlogged claims to accumulate on hold. When a qualified, well-respected and connected CVO like symplr CVO takes on practitioner enrollment, review of all claims on hold and validation of status of enrollment is expedited. Providers are enrolled quickly and accurately, speeding reimbursement.
Likewise, correcting customers’ pending applications with errors is familiar territory for a CVO. Sometimes it’s a simple typo; other times, a third party hired to manage physician enrollment made mistakes. To the insurance company, it’s all the same—they must deny your application. Reaching a human for resolution on the payer end is increasingly difficult for the typical provider organization, with its limited resources. Symplr CVO sees these kinds of mistakes often and knows how to navigate on behalf of our customers. Our team looks at every application, corrects the issues, re-submits to the insurer, and follows up until providers are enrolled.
How to get and use data from your CVO
CVOs perform critical business processes that affect the healthcare organization’s bottom line. Reporting on credentialing performance metrics—or key performance indicators (KPIs)—not only helps show the return on investment in your CVO, but also can demonstrate the need for additional resources.
When using a CVO to supplement in-house providers, ensure that the goals of each party are aligned. Best practice tips for gathering and applying the best and most useful data that a CVO will handle on your behalf follow.
- Develop one set of performance measures and reporting processes to be used.
- Eliminate duplication and create a clear and clean path for all credentialing staff to follow, and train them on it.
- Measure multiple data points along the lifecycle of enrollment and credentialing to pinpoint problems or delays. Many CVOs can and should be able to provide such data for you, helping you to improve..
- If possible, share the same provider data management software resource with your CVO.
Let symplr CVO navigate the complex credentialing, verification, enrollment, and licensure processes for you, so you can stay on track toward achieving your big-picture goals and initiatives.