Improve your credentialing efficiency, accuracy, and speed by leveraging technology.
Small practices must navigate the continually evolving regulations surrounding Provider credentialing, privileging, and Payor enrollment. These processes are necessary to run a profitable practice that delivers quality patient care. However, credentialing can be a complicated, tedious, and time-consuming process, mostly when handled manually.
Small practices manually process document acquisitions, verifications, and filling out Payor enrollment applications. They use spreadsheets to track progress. Furthermore, they often miss out on their re-credentialing deadlines and only react when the Payers send it to them.
While some practices continue to meet their ends using this old-school method, it is undeniably a struggle for independent primary care practices with reduced administrative resources. In our extensive research about healthcare administrations across the country, we’ve faced several common scenarios, which can cause a credentialing crisis. It can leave practices overwhelmed, including:
- Unavailability of Seasoned Credentialing Professionals. The practice now lacks seasoned staff who can manage the complex credentialing process. The situation leaves the practice without the ability to maintain ongoing or new credentialing. It leads to delays, cash flow issues, and non-compliance risks.
- The practice is expanding. Firms with an aggressive growth strategy, such as those taking over or merging with other practice groups, suddenly find they lack the resources to support a larger number of practitioners’ credentialing.
- Clinicians are entering private practice for the first time. When doctors start their practices, credentialing can quickly become a burden. They attempt to balance all the other necessities required to run a business successfully.
Instead, small practices can take the following four steps to streamline and safeguard the credentialing process with Santech’s I-Enroll.com, an intuitive platform for solo and small practices to manage Provider data and Payor participation. These steps allow small practices to stay on top of their current credentialing needs and increase their future organizational growth capacity.
1. Leverage a dedicated solution to managing Provider data credentialing and Payer enrollment
Small practices may rely on a small team — or even just one administrator — to piece together the entire credentialing puzzle. A practice administrator also may juggle several other duties, including front-end office management and back-end functions. Even though the administrator is profoundly efficient, there may not be sufficient time to execute all tasks.
Administrators can efficiently complete the credentialing process steps by replacing manual filing, spreadsheets, and email alerts with an automated solution. Thus, they can turn their focus back to other critical tasks. Moreover, if an administrator leaves the practice, it will be much easier to train a new staff member into the credentialing role since the heavy lifting is automated.
2. Provider self-service capabilities to alleviate the administrative burden
Provider self-service capabilities such as Provider self-sign up and managing Provider data via user-intuitive portals anytime anywhere reduce administrative burden. It empowers you with faster, streamlined provider data entry and management.
3. Never Miss Out on Expirables and Renewal Deadlines
Built-in tracking and reminder mechanisms will help ensure applications are submitted successfully and logs are produced for the Payor to approve participation. The solution should also have built-in rules to check each payor application’s completeness and mandated documents.
4. Organize all documents in a centralized system
One major challenge across all small practices is keeping track of the necessary credentialing paperwork pertinent to each clinician. Over 500 data points must be gathered for a typical clinician to perfect the credentialing process. It includes licensure, completion of residency, board certifications, work history, and continuing education. Missing documentation can cause significant delays in moving forward with Payor enrollments and may even put annual or semi-annual audits at risk.
That’s why practices must have one system that can store and track all required documentation and reference links. An automated credentialing software eliminates most hard copies, creates electronic versions, and automatically fills them. It removes the burden of organizing this paperwork. Practice staff can easily store and access all your documents anywhere/anytime, in a secure online repository.
Administrators can immediately pinpoint any items that are missing or expiring soon. It assures painless and successful audits since administrators can go straight to any file that needs an audit rather than filtering through thousands of physical files.
5. Automate Payor Enrollment to Save Time and Frustration
Payor applications are often the longest step of the credentialing process and are a significant source of frustration for most small practices. Numerous Payors function in the United States, and each has its different set of requirements, which can change annually.
Once a Provider application is presented, it can take from four to seven months to be processed. It may also require additional follow-up. Therefore, practices must submit applications quickly with 100% accuracy. Any missing data could lead to rejection, triggering further delays.
Choose the right software solution that has an extensive pre-mapped Payor form library. It should allow practices to auto-populate all Payor forms and generate application packets as per Payor’s requirements. With this capability, the system can fill out and apply applications for multiple practitioners faster and more accurately than the practice could handle manually. Once applications are submitted, one can track their statuses from within the system, eliminating the need for time-consuming follow-up phone calls.
For growing practices, automating Payor enrollment applications results in faster application submittal times. The more rapid practitioners can get enrolled with Payors, the sooner they can see patients and be reimbursed for their services, improving Provider and member experience.
How can I-Enroll.com Assist?
An efficient data management technology can help any small practice, irrespective of its organizational structure. It can help you get it done fast and done right. It enables you to avoid a potential credentialing crisis and set your practice up for success.
Santech’s I-Enroll.com is an intuitive platform for small and solo practices to manage Provider data and Payor participation. It can bring many more resources to the table with benefits including: –
- Paperless Credentialing
- Store Provider data and documents in a secure online hub
- Single click entry for the Payor application form
- Attest Payor applications with e-sign or wet signature
- Submit applications to Payors via electronic exchange/Email/eFax/mail
- Track application status in real-time
- Get notified on upcoming expirations and renewables
- Expedite enrollment and accelerate reimbursements
With a trusted technology partner, small practices will quickly get all Providers credentialed and enrolled with Payors. Thus, they could begin seeing patients immediately and build a solid revenue cycle foundation. To learn more, connect with our sales representative at +1.732.658.0072.