Validate your Referring Providers

Referring Provider Validation

Maintain an accurate, verified, and continuously-updated database of referring providers to feed clinical systems, optimize revenue cycle management, and mitigate risk. Easy, right? Not exactly. It’s labor intensive with unclear and redundant responsibilities across a multitude of departments. Referring providers are neither employees nor credentialed medical staff members. The numbers of referring providers and Affordable Care Act (ACA) requirements are rapidly growing. It’s time for a comprehensive solution to these expanding challenges.

VerityStream’s Referring Provider Validation Solution enables a hospital to establish a source of truth for referring providers, available as a stand-alone solution or as an integrated module within VerityStream’s provider credentialing, privileging, and enrollment solution.

Key Benefits

  • Dramatically simplify the labor-intensive process for adding new referring providers.
  • Ensure ongoing accuracy and compliance of your referring providers.
  • Automate the process of keeping referring provider contact information up-to-date.
  • Reduce claim denials related to missing or incorrect referring provider information.
  • Nurture your referring providers to boost communications, loyalty, admissions, and your share of referrals from splitters.
  • Allow physician recruiting staff to leverage the referring provider database, streamlining recruiting efforts and medical staff applications.
  • Achieve economy of scale efficiencies and greater ROIs for system-wide CVOs.
  • Streamline a circuitous process that necessitates an expensive call and triage from your Hospital’s Call Center.
  • Increase referring provider satisfaction.
  • Cross-reference your referring providers against our national dataset of providers.
VerityStream’s Referring Provider Validation Solution includes four integrated components:

Validate & Activate

  • Instantly confirm NPI number, eligibility to order and refer by Medicare, and medical license.
  • On-demand screening of OIG, SAM, other federal exclusion sites, and state exclusion sites at admission.
  • Immediately activate your referring providers and automatically set them up for continuous monitoring and expiration management

Update & Attest

  • Admitting staff easily update information online.
  • Learn the intuitive interface in a 15-minute training session.
  • Referring providers or delegates access the Hub to update profile information.
  • Automatically launch an online attestation process for referring providers on your own cadence.
  • Continuously monitor OIG, SAM, other federal exclusion sites, state exclusion sites, and CMS Open Payments.
  • Attain 24-hour validation: Mailing address, phone, and fax.

Integrate & Populate

  • Connect referring provider data to your EMR system daily with a built-in HL7 tool.
  • Automatically generate expiration letters or license emails to referring providers to secure required updates.
  • Review pre-built dashboard on referring providers to identify and analyze new, lapsed, and/or continuing referring providers.
  • Allow a referring provider to comprehensively update their profile at any time by “Claiming Their Profile” directly from CAQH.

Nurture & Optimize

  • Nurture referring providers through the Hub with automatically generated letters, emails, surveys, videos, best practices, or testimonials to/from referring providers.
  • Enable physician recruiting staff to leverage the referring provider database.
  • Support a single master provider database for employed credentialed, and referring providers.
  • Provide an online physician-to-physician consultation request feature in the Hub.

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