Buyer’s Guide Credentialing and Network Monitoring Software
5 Essential Steps for Choosing the Right Solution
Credentialing has long been a very manual process that is quick to be outsourced, but more network leaders are finding optimization opportunities that play a significant role in their overall network operations strategy. Not only is credentialing your first step in establishing relationships with providers, its downstream impacts go all the way to patient experience and continuum of care. Errors in the credentialing process can easily lead to an out-of-network referral and cost your patients hundreds or thousands of dollars in unexpected charges.
Without boiling the ocean, or taking on a complete digital transformation, there are practical steps you can take to change your process and see real results, quickly.
What if?
We designed this guide to help get you there with 5 essential steps to choosing the right credentialing and monitoring solution for your organization.
Step 1
Understand the Current Landscape of Credentialing and Monitoring Solutions
Most credentialing and monitoring solutions fall into one of three categories:
Each solution category has its place depending on your operational needs, technical maturity, and resource allocation.
Step 2
Consider Your Operational Needs Today and Future Goals
To find the right solution, audit where you are today and where you want your credentialing operations to be tomorrow.
Where is the greatest administrative burden in the credentialing process?
It’s common for manual workflows to cause administrative burden on both the provider as well as the operations team. When you look for the most problematic areas currently, these signal your greatest opportunity for optimization.
Who in the organization interacts with credentialing on a regular basis?
Ensuring these handoffs are seamless is a key factor in determining your needs for workflow automation.
Where is the greatest administrative burden in the credentialing process?
A follow on question to which teams interact with credentialing, this can also tell you which systems you will want your credentialing platform to integrate with. For many health plan organizations, the mission-critical system for all provider data to connect to is their CRM, such as Salesforce.
What do we want to glean from our provider data?
By asking yourself this question early, you can go into project scoping with a clear set of requirements upfront. Items like custom fields, pre-configured reports, or specialized data models may become part of your requirements—you will want to ensure these boxes are checked off early.
Step 3
Develop your technical requirements
Define stakeholder “must-haves” ahead of time to help narrow your focus when it comes time to start vendor evaluations. Ensuring that technical requirements align with cost and time savings metrics will help build your business case for approval.
Step 4
6 Questions to Ask Vendors
While many credentialing and monitoring solutions may look similar on the surface, they are not created equal.
Here are 6 questions to ask vendors you choose to evaluate:
- What provider types can you support with primary source verifications and data models?
- Which primary source verifications are automated without any human intervention?
- How can the solution help maintain an up-to-date provider directory?
- What level of customization and configurability are available?
- What types of reporting is pre-configured and what can be generated on demand?
- What are the average turnaround times your customers experience?
Step 5
Build Your Business Case
After gathering requirements and evaluating solutions, it comes time to prove it’s a worthwhile investment to make that can achieve short-term and long-term wins. Measuring your potential return on investment should include this multidimensional approach.
Immediate savings from vendor switch
Evaluate your current vendor contracts to understand your spend today. Especially those utilizing outsourced staff services and CVOs, the cost for this can reach up to 7-figures pretty easily.
First year savings from staff efficiency
Measuring savings gained through automation will depend on how you are leveraging delegation agreements, as well as the solutions being used today for credentialing and monitoring.
&
Credentialing/Recredentialing
Your current process will determine long-term savings
Sample Business Case
Profile
Regional Health Plan with 500,000 members, conducting some credentialing and all monitoring in-house
Weekly Compensation Equivalent Saved
Annual Compensation Equivalent Saved
$332
$17,261
Credentialing Events Expected In-House in Next Year
Annual Compensation Equivalent Saved
2,667
$128,221
% Displaced by Verifiable
100%
First year Savings (Compensation Equivalent)
Savings Per Member Per Year (PMPY)
$145,482
$0.69
Ready to Start
Exploring Solutions?
With Verifiable + Salesforce you can take advantage of:
- Intelligent Provider Profiles & Collaboration: Centralize profile data & insights to increase provider productivity and patient access to care.
- Error-Free, Fast Credentialing: Automate practitioner and facility workflows & documents to accelerate credentialing turnaround times. Faster medical credentialing = better provider experiences and network growth.
- Real-Time Trusted Source Integrations: Verify directly from required and recommended primary sources to receive instant feedback on network health and compliance.
- Proactive Network Monitoring: Access audit-ready reports & actionable alerts to stay compliant, understand your provider network, and reduce regulatory risk.