Bringing credentialing in-house with the right partner empowers today’s healthcare organizations to accomplish objectives like reducing the time to onboard providers, trimming credentialing costs and continuously improving the provider experience through technical operations and optimization. By automating the most time-consuming aspect of provider credentialing—PSVs—organizations experience speed and accuracy that manual processes can’t match.
However, bringing credentialing in-house can feel daunting. In-house credentialing requires expertise on regulatory requirements and process adherence, which is why choosing the right technology partner is imperative to the success of an insourcing initiative.
So just how exactly, can an organization bring their credentialing in-house with Verifiable? In simplest terms, you need the right people, process, and technology.
Insourcing myth: “I need a huge team of full-time employees (FTEs) to bring credentialing in-house!”
Insourcing truth: Although it’s true that staff is needed to bring credentialing in-house, it’s often fewer than anticipated. Verifiable automates all primary source verifications, packet-assembly, and parts of data entry to speed up process times. Using Verifiable, credentialing specialists can manage the entire process for a provider and complete, on average, 250 credentialing packets per month.
People to power your in-house endeavors
When bringing credentialing in-house, the number of full-time staff members needed will depend on provider count currently in your network, as well as any anticipated growth. When using Verifiable, ongoing monitoring runs on autopilot, allowing credentialing specialists to accomplish approximately 250 credentialing packets per month (compared to about 80 without automation). FTE requirements are also drastically less than those required in the traditional credentialing process, thanks to fully automated PSVs (including ongoing monitoring), auto-generated packets according to NCQA standards, and streamlined data entry through CAQH integration.
For an organization to anticipate their needs, it’s suggested they consider how many credentialing events take place in their network on a monthly basis. For example, as “back-of-the-napkin” math:
For organizations determining how in-house credentialing could work for them, it’s critical to review credentialing needs on an annual basis while anticipating growth goals and more. By scoping out potential credentialing events throughout the year, organizations can easily determine how many staff members are needed to verify credentialing in-house with Verifiable.
Easy to understand policies and procedures
To ensure compliance with the requirements behind healthcare credentialing, defined processes need to be in place. Thankfully, organizations like the National Committee for Quality Assurance (NCQA) have developed accreditation and certification programs to ensure minimum standards are met. When following their standard, organizational policies and procedures should include the following requirements:
How to uphold compliance standards and realize cost savings at scale
By choosing the right technology to support insourcing initiatives, organizations can successfully adhere to compliance standards, keep costs low, and provide an experience that providers and staff will appreciate.
The following capabilities should be on a “must-have” list when evaluating the right solution:
“CHA Nevada offers medical, dental, pharmacy, behavioral health care, and food pantry services across 7 different locations—and managing all of those service lines is something most vendors couldn’t do. But since Verifiable manages all lines of service, provider types, and locations, we were able to truly centralize our data. Now, we can view workflow status, manage provider records, and customize reporting all in one spot.” — Holly Long, Director of Population Health Management, Community Health Alliance of Nevada.
Return on investment through automation
With Verifiable, organizations see return on investment in a number of ways, starting with how the software is budgeted. Often, CFOs manage an outsourced services budget differently than the budget for software platforms and technology. Since these budgets are often separate, there may be more dollar availability for technology that helps achieve operational efficiency, since this is top of mind for so many executives.
Verifiable customers often see how return on investment comes with the replacement or reduction of a costly CVO. One such leading customer is Humana, who came to Verifiable searching for technology solutions to help insource away from their previous CVO vendor. Humana aimed to reduce costs, increase data quality and accelerate credentialing turnarounds to improve the provider experience. Humana chose Verifiable to insource, automate and centralize credentialing operations on the Salesforce platform. Through this work, Humana is currently projecting a 15 percent cost reduction, while improving quality and control over its previous CVO.
But ultimately, beyond the hard metrics of cost-savings comes softer advantages, like the peace of mind that comes with reliable data and cost transparency.