Centralizing Credentialing and Provider Enrollment Functions

Centralizing Credentialing and Provider Enrollment Functions

Nov 13, 2020
  • Author:
    Noelle Abarelli

Chances are if you’re reading this post, you’re acutely aware of how important provider enrollment and credentialing are within any medical system. With the amount of data that must be retrieved, processed, and maintained, having a system in place to ensure nothing falls through the cracks is crucial. And having all data in one centralized location is a major part of that puzzle. This is just one of the many findings that this year’s Annual Report on Provider Enrollment uncovered.

The State of Credentialing and Enrollment Unification

This year’s survey represents 563 responses from individuals involved in provider enrollment. Around three-quarters of the group affirmed that their organization had a unified credentialing process and application. However, responses varied significantly when assessing if respondents had the same department or software performing both credentialing and enrollment.

  • Only a third (35.4%) of organizations with an internal health plan (Group A) reported that they used the same department to perform both credentialing and enrollment.
  • Nearly two-thirds (63.3%) of organizations without an internal health plan (Group B) reported that they used the same department to perform both credentialing and enrollment.

While most organizations in both groups stated that they used a standard application to obtain provider data for credentialing and enrollment (78.3% of respondents of Group A and 82.5% of Group B), it appears that there is a variety of software being used to manage credentialing and enrollment. Only six in 10 (59.6% of Group B) said their organization used the same commercial software for both credentialing and enrollment. The question is—are these organizations missing out by not unifying their credentialing and enrollment resources?

An Expert Weighs In

We asked Kris Bigelow, Director of Enterprise Credentialing with Parkview Health, a network of more than 80 community hospitals and clinics in northern Indiana and northwest Ohio, to weigh on the data collected in this year’s survey. It appears that there is a lot to be gained by unifying the credentialing and enrollment functions. Some of Kris’ key takeaways include:

  • Whether or not an organization has a health plan, or regardless of how they might currently operate, the benefits of integrating credentialing functions and provider enrollment is evident. These benefits include:
    • The reduction of write-off deficiencies in workflows
    • Improved communication
    • Streamlining efficiencies
  • The foundational impact that Parkview Health has seen lies in improving provider data management with software to handle data management and documentation.
  • Through integration, data sharing has become more efficient and accurate, which allows the organization to trust in the data throughout the health system, leading to a more efficient and robust workflow.

What’s Next?

This year’s annual report showed us that there is heightened awareness about the importance of provider enrollment being part of the credentialing function. Separating the functions often means there is little interaction between the two teams, resulting in disparate processes and a lot of duplication of work. This can lead to provider frustration, long turnaround times for both provider enrollment and credentialing, and lost revenue. It can be a headache, and it doesn’t have to be!

As the industry and organizations embrace opportunities for credentialing and enrollment integration, and as clearly defined roles and responsibilities are developed, we hope to get closer to establishing industry practices. In the meantime, it’s important to stay focused on 2020’s biggest learning—that reducing enrollment timeframes is the single highest rated item, with 88.5% of respondents listing it as the #1 initiative for their organization. As we’ve established, integration can go a long way in helping reduce these timeframes.

With the amount of data collected in 2020’s Annual Report on Provider Enrollment, there’s something in there for everyone. So go ahead, take a look at the report yourself—download it here—and let us know what you think! As always, all of us at VerityStream are here to help with all your provider enrollment needs.