6 Benefits of One Source of Truth for Provider Data for Credentialing and Enrollment and How to Get There

March 20, 2023
March 20, 2023

Enrolling providers in health plans is a high-stakes function, especially for hospitals that are experiencing an increase in employed providers.

A recent VerityStream survey indicated 48 percent of Medical Services Professionals (MSPs) report that increasing numbers of employed physicians were having an extremely or very significant impact on their organization. The rapid increase in employed physicians and growing complexity around credentialing and enrollment requirements, continues to lengthen the time it takes to get providers to work.

With the average new provider generating $6,641 a day in revenue, every day enrollment is delayed costs money—lots of money. In fact, our research indicates that on average, hospitals typically lose $150,000 to $250,000 per provider during each of the first three years of their employment.

If you’re a MSP responsible for credentialing and/or enrollment, you may be feeling frustrated. We get that. Fortunately, our team at VerityStream is in a unique position to offer advice. Our experience helping more than 2,400 hospitals and 1,000 medical groups with credentialing, privileging, enrollment, and evaluation, has taught us a few tips and tricks for speeding these processes up. One of them is: data consolidation.

Data Consolidation Defined

When the relevant data required for credentialing and enrollment resides in multiple databases across different facilities—you’re sure to have issues with data redundancy and data inaccuracy. This will lead to a host of problems including compliance issues and poor provider satisfaction to site just a few.

Data consolidation creates a single source of truth for provider data, with one application and one reappointment date across all system facilities. A physician is in the system only once for all credentialing and re-credentialing purposes, removing the need for multiple spreadsheets and checklists. A single platform also offers workflow management and promotes proactivity, generating reminders about TJC, NCQA, CAQH, directory updates, and more.

Six benefits of data consolidation

1. Improve data accuracy

Redundant and manual processes across facilities make it virtually impossible to collect accurate data in a timely fashion. A single repository for provider data enables you to create an accurate dataset that can be shared across your organization. The ability to manage and audit data electronically, eliminates paper and rooms of wall-to-wall file cabinets while freeing up staff time to focus on data integrity.

2. Increased compliance

Health plan provider directories get their data directly from health systems. In January 2017, a CMS audit of Medicare Advantage online directories audited 54 parent organizations and issued 52 compliance actions. The report found that 45.1% of provider locations were inaccurate. Consolidation addresses this risk by establishing a centralized repository for collecting, storing and communicating the most up to date, accurate information on locations, phone numbers, specialties, and more.

3. The ability to take advantage of delegated credentialing

The holy grail in enrollment is delegation. Delegation means the payer has delegated the credentialing process to the healthcare system and agrees to accept their paperwork. The payer also agrees to accept the credentialing committee’s decision date as the provider’s start date, often times cutting weeks out of the provider enrollment process. Without delegated credentialing, the health plan determines the effective start date, placing provider revenue at risk. Delegation gives your health system greater control over time-to-revenue.

4. Streamlined reporting

A single data set facilitates system-wide reporting that also integrates with your EMR. Instead of dedicating resources to cobbling together reporting, the staff can concentrate on trouble shooting issues and improving processes.

5. Enhanced provider satisfaction

Providers want to focus on the providing care to their patients—not providing redundant data. A fragmented approach to collecting the data required for credentialing and enrollment is sure to drive down provider satisfaction. A single point of entry where all stakeholders, including providers, chairs, and chiefs can go 24/7/365 to input and access the information they need greatly improves the provider experience and reduces onboarding timeframes. While it’s difficult to monetize provider satisfaction, declining engagement surely correlates with declining revenue.

6. New levels of collaboration

Redundant work processes also frustrate the credentialing and enrollment staff. Sharing provider data across your organization requires collaboration among diverse groups who may not have typically worked in close concert before: a project manager and other representatives from credentialing, IT, and hospital administration. A new collaborative process results in teams who question processes and how they operate. While consolidation can create trepidation about job security or loss of control, it’s important to note that the process improvements it yields often enhance job satisfaction. Credentialing and enrollment have evolved, and best practices have emerged that save time by eliminating cumbersome steps from everyday workflows.