In April 2012, CorVel Corporation wanted to credential 35,000 practitioners in just 45 days and transform its credentialing system to drastically improve its scores on increasingly stringent audits to secure an at-risk contract.
Nikki Proffitt, a credentialing veteran with more than 20 years of experience, agreed to help CorVel reach their goal – on one condition. She’d work for CorVel, if she had access to Vistar, a credentialing platform Proffitt had relied on in a previous role with another large organization, Virginia Premier, since 2007. In May 2017, symplr, a leading provider of software as a service (SaaS) based healthcare compliance and credentialing solutions, joined forces with Vistar Technologies, which develops and supports provider management software for healthcare providers, managed care and payer organizations.
“CorVel gave me Vistar credentialing and the human resources needed to align their credentialing with clients’ contract requirements and on our next audit, we scored 99.8%, up from much lower scores, which more than satisfied the client,” says Proffitt, who notes CorVel upgraded to eVIPs from the desktop version in 2014. “As a result of our credentialing protocol and eVIPs credentialing, we have the utmost confidence our credentialing will stand up to the most rigorous audits.”
Today, Proffitt and her six full time credentialing specialists manage the credentialing of about 143,000 practitioners at 7,000 healthcare facilities across the U.S., Puerto Rico and the U.S. Virgin Islands, with a turnaround of approximately 40 days. A seasoned credentialing expert, who remembers relying on manual, paper-based systems to credential, Proffitt knows credentialing intimately and appreciates eVIPs developers’ ability to understand the credentialing process from the inside out.
“symplr’s eVIPs flows along the same path and works through the identical steps an experienced credentialer would take,” says Proffitt, who notes symplr regularly enhances the platform based on feedback from users such as herself. “eVIPs works exactly the way my brain works – it’s as if they put my brain on the screen.”
In compliance with CMS, NCQA, URAC, and TJC requirements, symplr’s eVIPs’ superior credentialing functionality supports primary source verification (PSV), tracking and verifying the education, work history, licensing, renewals, affiliations and references, continuing education, expirations (licenses, insurance, boards, sanctions) and much more with the original source of a specific qualification. Its ability to auto-populate drastically reduces the possibility of human error and reduces the time required to pull manually.
“Check the boxes to tell eVIPs exactly what you want verified and it pulls the paper verification into the system in two seconds versus the five minutes it would take my staff to do it manually,” says Proffitt. “It’s a massive time saver and reduces human error to improve accuracy.”
Finding experienced, reliable credentialers is always a major challenge, because it’s a niche role and credentialing specialists tend to stay put once hired. Proffitt knows eVIPs is the ultimate trainer, systematically leading credentialing team members through every necessary step in an established, logical sequence. Proffitt has successfully hired less experienced individuals and in fact, an individual who’d never even heard of credentialing, is now CorVel’s most productive team member due in part to eVIPs’ support. She consistently processes 220 to 300 practitioner files monthly, working 30 hours a week compared to colleagues who average 160 to 200 a month working a full 40-hour week.
Credentialing specialists, who must complete at least 140 credentialing records per month to meet CorVel standards, rely on symplr’s eVIPs reports to see their real-time time completion status.
“The report tells them what they’ve actually accomplished versus what they believe they’ve done to keep them on track and accountable,” says Proffitt, who notes it also inspires a sense of competition.”
About 10% of Proffitt’s time is dedicated to eVIPs Dynamic Import Utility tool which reduces her staff’s manual data entry time by about 60%. The tool imports data from multiple sources, such as CAQH as well as client-specific data sets that are related to delegated entities and CVO verified data. It also lets the client map each data set with conditional requirements and rules.
“With Dynamic Import Utility, I need six credentialing specialists, but without it, I’d need at least double the staff – eVIPs essentially paid for itself upon installation,” says Proffitt. “We couldn’t do what we do as accurately or quickly without eVIPs.”
Proffitt and her team also rely on the automated National Provider Data Base, which interfaces with NPDB’s Querying via QRXS, NPDB’s Continuous Query Service (PDS). CorVel typically runs it four times a day, pushing about 80 files each time, which takes the automated system less than a minute. It enters the data requirements, stamps the user and verification, and pulls in the image for every practitioner on the “push”. It would take at least 10 minutes per provider to manually pull each one from the NPDB, save it, then upload it to eVIPs, which doesn’t include the downtime as the individual waits for the return file.
“We run well over 200 NPDB queries a day and using eVIPs’ automated capability takes about five minutes compared to the two days it would take one of my employees to pull,” says Proffitt.
Every week, Proffitt and her staff rely on the automated Practitioner Signoff function to signoff 450 to 600 files. Practitioner Signoff updates the seven mandatory fields in practitioners’ records in less than five minutes, a tedious task that would take a fulltime employee 13 to 30 hours to complete.
“Automatically populating fields ensures human errors aren’t cascaded through the entire system,” says Proffitt.
CorVel’s contracting team uses eVIPs’ Contract Management component to manage pre-contracted and renewal contract negotiations. It organizes, standardizes and streamlines the contracting processes and captures contract details such as sentinel events, trigger dates, configuration efforts, process steps, fee schedule information, and manage contact information and contract development.
“Before eVIPs, all of our contracts were managed manually and eVIPs supports the implementation of additional protocols for each step and tracks timeframes,” says Proffitt.
eSearch lets credentialers run queries based on preset search criteria and research provider information in the eVIPs solution. Post-search, eSearch displays a roster of the records being processed, so the end user can click on a particular record and view full practitioner information including images, confirmation dates, enrollment statuses and more.
“We use it to see if a practitioner or facility is active before loading contract information,” says Proffitt.
A credentialing veteran, who knows exactly what she needs from her credentialing tools, Proffitt regularly customizes and troubleshoots the system herself rather than wait on CorVel’s support teams. The symplr eVIPs team is completely transparent and accessible to Proffitt which gives her total control over the platform she and her team depend on. She customizes eVIPs’ multilevel security, determining which credentialing specialist can see and manipulate certain reports or fields.
“I’m not an IT person, but symplr’s eVIPs is so intuitive that I can fix 98% of the issues myself,” says Proffitt. “My ability to self-manage CorVel’s rules and regulations and self-triage saves us all an extraordinary amount of time and hassle. I’m in complete control of our credentialing platform and I appreciate that.”
As much as Proffitt and her team rely on eVIPs, Proffitt knows that she is in charge of CorVel’s credentialing, not eVIPs or symplr. To maximize eVIPs implementation, Proffitt recommends focusing exclusively on your organization’s credentialing process, then asking exactly how eVIPs can automate, streamline and enhance it.
“Identify the desired outcomes and work backwards from that to help symplr identify how it can improve on your best practices,” says Proffitt. “symplr can’t tell you how to do your job, but they can leverage eVIPs to help you do it even better.”
CorVel provides risk management solutions to the workers’ compensation, auto, health and disability management industries across the U.S. The organization provides its customers with the information and insight they need to make smart decisions.
FACILITIES: 10,000 healthcare facilities across the U.S.
FULLTIME EMPLOYEES: 6
PRACTITIONERS: 143,000 nationwide
eVIPs PROVIDER MANAGEMENT PLATFORM
ADDITIONAL MODULES USED
Dynamic Import Utility (DIU)
Unacceptably low audit scores jeopardized key contract(s)
Existing system lacked full credentialing capabilities
symplr’s eVIPs provider management system for credentialing, Dynamic Import Utility (DIU), contract management, eSearch.
99.8% audit scores attract, preserve/retain key contracts
Automated, full credentialing capabilities with eVIPs
Affordable credentialing system recoups ROI upon implementation