How to create a delegated credentialing program?

Credentialing Services

This is part two of a two-part post that evaluates what is delegated credentialing and why healthcare provider organizations should consider it.

As explained in the first post of this two-part series, delegated credentialing is an opportunity for large provider organizations to take matters into their own hands, streamline processes and realize substantial benefits. These include getting providers credentialed quicker so they can generate revenue and expand clinical bandwidth.

So, how do organizations create a delegated credentialing services process? It entails establishing processes, as well as implementing tools to assist with workflow and manage the flow of data.

Key processes to implement include:

  • Adopting Credentialing Standards — The National Committee for Quality Assurance (NCQA) has already established standards for payers, as has the Joint Commission for providers. Standards from both organizations should be adopted, as well as any specific standards from regional payers.
  • Establish a Review Process — Create a committee to define processes and review provider credentialing.
  • Conduct Ongoing Monitor — Develop processes to continually monitor work quality.
  • Re-Credentialing — Create processes to easily re-credential providers on an ongoing basis.
  • Create Agreements with Payers — Delegated credentialing agreements need to be established, clearly stating structure and metrics, including:
    • Outlining the responsibilities of the payer and delegated entity.
    • Detailing metrics of how the payer can define and assess performance.
    • Developing ongoing oversight processes.

Accomplishing these processes requires sophisticated credentialing software that includes:

  • Analytics and reporting
  • Dashboard presentations and milestone tracking
  • Demographic import features
  • Document management
  • Reminders and notifications
  • Task management and assignment features

A key resource to assist with delegated credentialing programs is the Healthcare Billing and Management Association (HBMA). The organization has a number of useful resources that expound on the above in further detail.

Author Julia Solooki is a board member of the HBMA Education Committee.

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Credentialing Dashboards Part 2 – Additional Capabilities to Evaluate  

Last week we wrote a brief overview of credentialing dashboards and several people contacted us with questions about additional dashboard capabilities. To address some of those questions, we’re highlighting some other important dashboard capabilities in this week’s post. Below are several key capabilities to look for when evaluating the dashboard components of credentialing solutions.

Milestones — Dashboards also need to display progress toward, or the completion of, key milestones so users can view specific activities within the credentialing process. This enables users to quickly know what’s completed, needs to be done, is past due, and what are the new tasks that are entering the process.

Drill-Down Capabilities — An overview status of processes is valuable, but users typically need more information. Drill-down capabilities allow users to click on elements of the dashboard to display specifics, whether it’s information about individual providers, payers, or other elements of the process. This enables users to efficiently get the information they need within one or two clicks.

The Ability to View Tasks and Processes from Different Perspectives — Not all users of the dashboard are looking for the same type of information. Some may be interested in looking payer-specific details, while others are more focused on working on tasks related to individual providers. The dashboard needs to accommodate these perspectives in its display to improve staff efficiency and improved workflow. For example:

  • Payer Information — Sections of the dashboard should display payer-related information, such as payer contact details, insurance PDF forms specific to the payer, web links, as well as counts of providers with insurance and their credentialing status.
  • Provider Information — Other sections of the dashboard need to display provider-specific information, such as the number of providers being credentialed and the status of specific tasks within the process. Drill-down capabilities within the section of the dashboard should enable the viewing of details, including in-depth provider profiles that include all credentialing-related information, as well as the wealth of information imported from the Council for Affordable Quality Healthcare (CAQH).

Specialized Capabilities — It’s important for dashboards to be user friendly and include features that make it easier for the staff to complete their jobs. Leading credentialing solutions include advanced features such as the ability to easily attach documents to records within screens, and capabilities to upload information from other data sources (e.g., CAQH and others). These capabilities reduce data entry, and make documents easier to find.

With dashboards, everyone remains on the same page and is up-to-date with the status of tasks, which increases the efficiency and effectiveness of the credentialing process.

Credentialing Dashboards Keep Staffs on Task, Better Communicate Status

Credentialing Services

Dashboards. To some, the concept is met with open minds and eagerness to view the data in a snapshot. To others, the term conjures up a notion of marketing spin. Can anything really be that great? The answer is yes. If done well, dashboards can not only brilliantly communicate key data to your staff, but keep everyone on task and efficient.

When looking at physician credentialing, communications are a vital part of the process, as everyone needs to know the status of tasks—what’s in progress and what remains to be completed. This information needs to be shared among various stakeholders, such as the credentialing staff, providers, practice administrators, and others. For credentialing, communicating this information is vital to practice operations, reducing risk, and ensuring that providers are eligible to receive reimbursement for their work.

Using a credentialing software solution with a dashboard display is an ideal way to share this information in a format that is easily digestible so information becomes actionable. Dashboards are a graphic representation displaying an up-to-date snapshot of tasks, whether they’re newly assigned, in progress, on hold, or past due. A credentialing system dashboard should be easily accessed, and provide an overview snapshot, milestones, drill-down capabilities, and the ability to view tasks and processes from different perspectives. Here’s a look at the first two of these.

Easily Accessed — When users open the credentialing system, the first thing they should see is the dashboard display. This quickly communicates the status of tasks, and alerts them to issues that need resolving. The easy accessibility of the dashboard eliminates the need for users to click through menus to view the information. It also decreases the chances that important information will get ignored, overlooked or simply not communicated.

Overview Snapshot — The dashboard should display a broad overview of the process that users can click on to get more detail, also known as “drill-down” capabilities, which are explained below. This overview enables the dashboard to display information of value to multiple user types, whether they are providers, practice administrators, or the credentialing staff. The dashboard should display:

  • Status of providers being credentialed (e.g., new, in process, on hold, completed, or custom credentialing)
  • Counts of providers with insurance
  • Status of the credentialing process by task
  • Credentialing task aging (e.g., 0-30 days, etc.)

Start by looking for these items in your dashboard, and watch your credentialing process go more smoothly.

 

*Photo is under Creative Commons License.

How to Select Credentialing Software

Whether you’ve done it just once, or hundreds of times, you know that physician credentialing is a labor- and time-intensive task. On the flip side, it’s also mandatory if you want to earn reimbursement from payers while also minimizing risks for your practice. Fortunately, there is a silver lining. Software solutions are available to help manage the process. Here are some key features to look for when selecting physician credentialing software.

Cloud-Based. It’s important to look for a cloud-based solution as opposed to traditional software that must be physically purchased on a disc, manually installed and then maintained. Cloud-based solutions can be easily accessed via a browser, are available on a pay-as-you-go subscription basis, and upgrades can be done quickly and nearly effortlessly from any location.

Automated reminders and alerts. Reminders and alerts are critical to notify users when tasks need to be completed. For example, credentialing software can remind users in advance when physicians require re-credentialing. Alerts help notify of important upcoming dates, such as when physician certifications and licenses are about to expire. These reminders and alerts, combined with reports listing upcoming tasks, help facilitate greater efficiency so organizations can always stay on top workloads.

Convenience features. Credentialing software solutions should also provide numerous other conveniences. Once physician demographic and other information is entered, the system should be able to reuse that information to pre-populate forms and other materials. In other instances, some software can also remove the need for data entry by pre-populating the physician data. Look for a system with import tools that allow for the seamless extraction of provider information from various forms, including insurance company forms and the PDF documents from the Council for Affordable Quality Healthcare (CAQH). Then, once imported, this information can be used auto-populate other forms. This eliminates the lengthy and time consuming process of re-entering information.

Document management. Systems should include document management capabilities to store forms, correspondence, credential verification materials, and more. This saves time by properly organizing documents into a logical order that can be easily navigated for quick reference, and rids office staff of the stacks of folders with hard copies.

With the right software solution, credentialing can be a more streamlined and consistent effort throughout any organization. With the right software, you just might welcome the new staff physician who needs to be credentialed.