symplr Provider platform from symplr

CUSTOMER PROFILE

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Southern U.S. Healthcare Organization

NUMBER OF HOSPITALS: 3

PROVIDERS: 1,350+

LICENSED BEDS: 950+

OUTPATIENT ENCOUNTERS: 1.5 million

 

KEY CHALLENGES

  • No centralized provider data repository

  • All provider data manually updated

  • Provider data in either paper files or Excel spreadsheets

  • Difficult for staff to find and access provider data

  • Ineffective payer enrollment data tracking system

  • Late or inaccurate payments and sometimes none at all

 

SOLUTION

symplr Provider Platform, Cloud-based Cactus XML, Provider Privileging, Affiliation Letters, Application Manager, License Monitor, Payer Enrollment.

BENEFITS

  • Centralized provider data repository

  • All provider data is automatically updated and pushed out/shared

  • Data resides on a single integrated digital platform

  • Staff instantly access any data for which they have clearance

  • Payer Enrollment module is timely, accurate and efficient

  • On-time, accurate payments to providers

In the Southern U.S., the Medical Staff Affairs team at a healthcare organization with three hospitals and more than 1,350 providers, relies on symplr Provider to automate the routine processes and pull the massive volumes of data required to keep the credentialing, privileging, and licensing current and ensure providers are paid accurately and on time.

Because of the symplr Provider platform, which offers automated credentialing, privileging, payer enrollment, quality and risk management with cloud-based access, the health system and its hospitals’ Staff Affairs Director can have the correct answer to virtually any question in seconds.

“Before symplr Provider, I would have needed an additional three, full-time employees to achieve what my existing team can do with symplr Provider. Ask me virtually any question about our providers and with a couple of clicks, I give you what you need to know. That speed and accuracy are thanks tosymplr Provider and were utterly impossible with the glorified Excel spreadsheets and paper files we used to rely on.”

symplr Provider is highly automated to allow staff to handle routine, repetitive administrative tasks and manage data so they can do their jobs as accurately, confidentially and efficiently as possible. symplr Provider pulls relevant information from the outside organizations’ databases, then delivers that data through every symplr Provider component or module that requires it.

Do you need to know who was credentialed in a certain time period? The information is available in symplr Provider for anyone that needs it, if they have the security clearance for that particular level. In most instances, the medical staff office can obtain the data required to complete tasks themselves, but if not, the Medical Staff Affairs Director and his team can get it almost instantly. symplr Provider gives the health system the ability to control the data in every single field with simple, but sophisticated security gating based on user identity. The health system can also build user groups to give one group a view of five fields while another will be able to see twenty.

“The time savings are truly unimaginable – I couldn’t begin to accurately quantify it. Thanks to our centralized data repository and the hyper-flexibility of symplr Provider – everything we need is at our fingertips, and we’re not waiting on one another for information to take the next step.”

More than a decade ago, all provider data was still manually pulled and updated and when the Medical Staff Affairs Director discovered his predecessor had purchased the symplr Provider license but never had it installed, he got it done. As he put it, “I had no experience whatsoever with symplr Provider, but I figured it had to be a major improvement on our manual processes and as it turns out, symplr Provider does what we need it to do.”

 

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Prior to Cactus, if the Medical Staff Affairs team required information on a provider, they had to dig through Excel and even paper files to find it. Preparing any report typically took a couple of days, because of the time and effort required just to find and compile the data let alone assess and analyze it. A task as simple as sending three references per provider and verifying a provider’s education, internships, and residencies took hours because names and addresses for dozens to hundreds of providers were manually keyed into each letter.

“Data entry alone created an administrative burden around privileging, credentialing, and beyond. It was incredibly time-consuming, and every time data was rekeyed, the possibility of errors increased.”

Since mid April 2017, the health system has used Cactus Payer Enrollment to take advantage of the opportunities available to optimize the accuracy and timeliness of the data the payers required. The Cactus Payer Enrollment module pulls the information it needs, such as dates of birth, social security numbers, National Provider Identifiers (NPIs), taxonomy and more, from the health systems’ centralized data repository that Cactus has already populated. The previous system required staff to obtain data from a variety of internal databases and physical locations and re-enter it, which created a time lag and increased the possibility of errors.

“Ultimately, Payer Enrollment will eliminate the bulk of the corrections and drastically decreases the chance that incorrect data will be replicated because we won’t be cutting and pasting. If our providers aren’t correctly enrolled with payers, payments are inaccurate and delayed, and sometimes they don’t get paid at all. If they don’t get paid, no one at the health system will have a job.”

Payer Enrollment is highly efficient and effective, in part because at least 90 to 95 percent of the information it requires already exists. As importantly, a significant percentage of the data comes from the credentialing and privileging side of the house, so it’s already been primary source-verified. If providers work with Medicaid and/or Medicare, Cactus auto-populates the appropriate applications, all of which had previously been handled manually. In fact, the profiles which are built as providers come onboard can simply be attached to enrollment applications.

“Aside from the tangible benefits, such as being able to do so much without adding to our head count, our providers are paid, but even better, the payments received are timely and accurate. That broadly reduces the frustration and stress levels internally and externally.”

Cactus also has “flat-file capability” which stores data in a plain text file and puts just a single piece of information in each line of text. As a result, readers/users are less likely to inadvertently miss or skip a line and because users find it so much easier to read, they can easily scan a file four times as quickly.

“We access and process the data more quickly to expedite the turnaround to the payer. I can run a query on 1,000 providers and export it to a flat file in 60 seconds and as a result of that capability, my head no longer swims when I get that type of query.”

As much as the health systems’ Medical Staff Affairs Director and his team appreciate Cactus, the IT department appreciates the professionals at Cactus even more. Why? When team members call Cactus support, they talk to a real person, and if it’s after hours, all calls are returned as promised. Cactus also follows up on its commitments, at the time and on the day specified.

“If they haven’t heard from us, they’ll call just to see how we’re doing. We’ve come to expect and rely on a certain level of service from Cactus and have seen that they do what they know works best for their customers."

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