Visit IPM Pulse, our blog dedicated to the healthcare payer community and Integrated Provider Management (IPM).

Credentialing

The Credentialing solution enables health plans to reduce their credentialing costs and network liability.  It automates the provider credentialing lifecycle, including: intake, primary source verification and committee review management. Additionally, it manages the re-credentialing process.

Business Challenges:

• Ensuring minimal network liability through accuracy of credentialing
• Continuous external change in provider credentialing data, including sanctions
• Periodic change in primary source content and access
• Multiple manual and error prone look-ups of primary verification sources
• High cost paper-based tracking of credentialing
• Difficulty in electronic exchange of data with downstream systems
• Cost effective support for delegated credentialing

Key Features:

• Credentialing for all provider types (practitioner and facility)
• Automated integration with primary source verification (PSV) sources (e.g., CAQH, NPDB, DEA, etc.)
• Fully integrated CAQH Universal Credentialing Datasource and sanctions
• Provider self-service for credentialing and re-credentialing
• Credentialing committee process management
• End-to-end workflow visibility through drill-down dashboards
• Automated hand off to contracting and provider set-up process
• Storage and retrieval of credentialing documents
• Industry leading, flexible information model

Key Benefits:

• Administrative cost reduction across credentialing operations
• Increased staff performance through automated credentialing workflows
• Enhanced cycle time management and trending through increased process visibility
• Reduced redundant data entry and improved data accuracy through trading partner integration
• Enabling increased service excellence through reduction of administrative burden on providers
• Increased ability to electronically share credentialing information across the enterprise