Provider Enrollment: Earning CIO Support on the March to Consolidation

Enrolling providers in health plans is a high-stakes function. Failure to enroll a provider with Medicare and other payers means a doctor cannot bill for services. On average, health systems with more than 100 providers participate in 10 – 29 different health plans. With the average new provider generating $10,122 a day in revenue, every day of delay in enrollment is very costly.

For many healthcare organizations, provider data reside in multiple data bases at multiple facilities. Even when enrollment is timely, if the same provider is credentialed seven or eight different times by member facilities, directory errors are more likely, resulting in patient confusion and compliance problems.

Centralization of credentialing and enrollment activities can resolve these issues and help healthcare organizations operate as systems instead of loose confederations.

Because of the significant effort and investment of resources required, successful consolidation requires executive leadership commitment. This includes candid, honest, and transparent dialogue among the key decision-makers, especially chief information officers. At its heart, consolidation is about data standardization, coding, and integration.

Health system CIOs have an ongoing responsibility for integrating mission-critical systems with other systems. Typically, they’re dealing with the EMR, feeding internal data bases, reporting, and managing the labor associated with database administration and code conversion. As a result, when a health system is evaluating consolidation, CIO support for deploying IT resources is essential.

Initially, the CIO is thinking, “If I sign off on this project, I’ll have to give up my database administrators (DBAs).” Suppose, for example, a CIO has 10 DBAs and maintenance staff working on systems like Kronos, PeopleSoft, and Epic. It’s a big deal to pull a resource off those efforts to reconstruct or build a new credentialing and enrollment system. There are no pools of technical experts ready to be thrown into a new integration.

So, when it comes to consolidation, it’s important to remove as many pain points as possible for the CIO. These leaders are focused less on the outcome and more on the process for getting there. They want to know “How straightforward is this going to be? We can only divert resources for a well-defined project.”

For the CIO, “straightforward” translates to buttoned-up project plans, project road maps, assignment of responsibilities, and success metrics. The consolidation team leader must be clear and honest about the level of resource commitment required and be willing to listen to IT concerns. The team leader who can provide a 6-9-month timeline—breaking out milestones by the month, week, and day—has taken an important first step toward getting IT support on the march to consolidation.