The Importance of Integrating your Provider Enrollment Processes

The Importance of Integrating your Provider Enrollment Processes

Nov 18, 2021

Author: Noelle Abarelli, Contributing Writer, VerityStream


In the fast-paced, technology-driven world we live in today, it’s natural for processes to change and improve, and that’s no different when it comes to provider enrollment. That is precisely why VerityStream has been conducting an annual provider enrollment survey for the past five years. The results we gather help us paint an accurate picture of the trends we see in the industry, how the industry is working toward process simplification and automation, and much more.


One thing is for certain, provider enrollment within any medical system requires diligence and accuracy. For the purposes of this year’s survey, we defined provider enrollment as the process used to establish eligibility to submit claims for government payers and contracted commercial payers, including locations in which a provider will render services to patients. This can include a number of types of providers, such as physicians, nurse practitioners, occupational therapists, and physician assistants. The main lesson learned from this year’s report is that organizations are determined to implement methods that streamline their workflows to gain efficiencies and realize revenue as soon as possible. And companies are integrating their operations in service of that very goal.


We present the top five key trends in integration provided by 459 provider enrollment professionals that responded to our 2021 survey.


#1 Standard Application


Our survey found that to successfully integrate operations, a standard application is essential. 91% of respondents said their organization uses a standard application throughout their health system to obtain information from new providers for credentialing, enrollment, and health plan purposes. That’s an overwhelming majority; clearly, a simplified process like having one consistent standard application throughout the hospital system works well, based on its almost total adoption. What if there were one solution available to house and manage one standard application?


#2 Centralizing Operations


When it comes to centralizing operations, 62.4% of the respondents stated the same department completes both credentialing and enrollment. And of these respondents, 65% of them have been integrated for over five years. This is an increase when compared to 2020, when that number was sitting at 50%. Once again, we're seeing an increase in organizations realizing the benefits of centralizing operations. If one department is responsible for both credentialing and enrollment, wouldn’t it make sense to have both tasks integrated and managed by the same software solution?


#3 Data Sharing


Another main takeaway from this year's report is that the integration of provider data is becoming more and more evident.  When asked if their enrollment systems received and/or provided data to other applications, we discovered:


  • 52.5% reported they both receive and provide data
  • 32.1% reported they provide data
  • 15.4% reported they receive data from other applications

The data we collect in our day-to-day work is valuable, and cannot be underestimated. The information collected during enrollment can be used to feed other functions, like billing, onboard recruiting, database systems, health system data warehouses, public facing directories, and much more. Having the flexibility to share that data as-needed saves time and money, and increases accuracy, as the same data set is being used across departments. What if all that data could be housed in one central location?


#4 One Software Platform


We believe, and this year’s annual report clearly supports, that having one software platform is key to successful collaboration and data sharing. Based on this year’s results, we know that 72.7% of respondents reported that the commercial software they already had in place was also used to manage their credentialing (note, this is any software, not only clients for which we work). 62% reported that the same software was also used to manage enrollment, and almost 6% said that same software was used to manage their health plan. Clearly, there is real value in having a shared platform to manage core provider data.


More and more organizations are integrating their processes in the name of efficient collaboration and data sharing. What if you could have one solution designed to serve the complete provider lifecycle?


#5 Data Governance Policy


With integration comes the need for data governance. Data governance is an organization’s process to create a solid provider data foundation that is built upon clearly defined data standards. Survey participants were asked if their organization had implemented a provider data standards guideline or policy, and 60% said they had. And 74% of participants indicated they have a procedure in place to communicate and complete provider and location changes internally.


We believe data governance is of huge importance in the medical credentialing field, not only in terms of setting up a global standard policy, but in assisting larger organizations with the approval process. In organizations with a higher level committee approval process, data governance can help to reconcile data elements that need to be reviewed and approved by certain parties. What if there was one shared platform that housed all necessary data while facilitating both credentialing and enrollment?


There are many other data points our 2021 Annual Report on Provider Enrollment uncovered, like how “reduce the time to enroll provider” was the single highest rated item of importance at 88.2%. This, along with the rest of our findings, is a strong indication that streamlining processes, embracing automation, and utilizing technology will continue to be relevant as time goes by.


We’re certain the results of our survey can help you implement initiatives that will impact your organization, improve financial results, and increase provider satisfaction. Download the report today. And if you’re looking to implement a single software solution to handle all your credentialing and enrollment needs, look no further. Schedule a free demo with us, and let us show you the benefits of setting up a single source of truth for your entire provider lifecycle.

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