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SKYGEN USA

Time for provider credentialing to join the Digital Age

By Mike Lessila

SKYGENUSA Powering Healthcare for the Digital Age

AUTHOR: MIKE LESSILA, DIRECTOR OF CREDENTIALING SERVICES

For most providers, the credentialing process must feel like the movie Groundhog Day.

The office receives a multiple page application that must be filled out in order to add the provider to the payer’s network. The provider or a staff member then dutifully fills out the application and mails it back or (in the more “progressive” instances) submits it online. Next week, another application comes in asking for the same information and the office goes through the process again. Rinse and repeat for each payer’s provider network.

That system might have been acceptable before the Internet became a part of our daily lives, when claims processing and benefits management were manual, offline processes. But here in the Digital Age, submitting provider credentialing one payer at a time seems rather archaic.

Think about the process you go through to look for a new car. If you have your eye on a particular make and model and want to find out which car dealers in your area have it on the lot, and at what price, you don’t have to visit each dealer in person or even contact each dealer individually.

Instead, you can simply fill out a single online form, and 20 minutes or so later your email box will explode and your phone will be ringing incessantly with dealer calls. It’s simple and convenient, requiring minimal effort on your part to receive the maximum benefit.

That same level of convenience has now been brought to provider credentialing. The truth is, every payer asks for the same basic information. Sure, there may be one or two items specific to a particular payer, but for the most part filling out the application is just like Groundhog Day.

So it makes far more sense to use a centralized Credentialing Service where providers enter their information once. And then payers download the information on-demand for a nominal fee instead of spending up to $200 (or more) per provider to build their networks.

Using a centralized Credentialing Service reduces the time it takes for providers to complete a credentialing application from 2-3 hours, multiplied by the number of payer networks they want to join, to a one-time effort of less than 30 minutes. This “one and done” approach also means providers become active members of the network faster, because payers don’t have to wait for those applications to be filled out. That means better reliability and access for patients and members.

A centralized Credentialing Service eliminates the issue of data errors on credentialing application submissions since providers are not filling out a new application each time they wish to join a new network. Once it’s correct in the database, it’s correct until something changes on the provider’s end. A well-designed Credentialing Service even reminds providers automatically when it’s time to renew license information or re-attest to ensure the information always remains current.

Groundhog Day is a fun movie to watch. But it’s not so much fun to live it. Fortunately, a technology-enabled solution is now available to move provider credentialing into the Digital Age.

If you’re a provider, how much time would it save you and your office staff in a week or in a month by using this service? If you’re a payer, would you rather chase down each provider individually or access a centralized database to obtain credentialing information in minutes? If you’d like to share your comments or learn more, leave your comment and contact information below.

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Mike Lessila

ABOUT
MIKE LESSILA

As Director of Credentialing Services, Mike Lessila is responsible for all of SKYGEN USA’s credentialing-related services and operations. This includes leading the internal credentialing function, working on growth strategies to increase the Credentialing Services provided to clients and managing SKYGEN USA’s Credentialing Service Hub and its rapid growth in the industry.

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