Credentialing Resources
Take deep dives into credentialing news, best practices, and technology with the andros team.
Enabling Provider Data Management with the Andros Credentialing API
Behind the scenes of every healthcare organization lies a complex web of credentialing processes. Credentialing is a cornerstone of quality healthcare delivery, ensuring that every provider in a network meets rigorous standards. Traditional credentialing processes are often slow, manual, and prone to errors, leading to delays in patient care and provider onboarding. Manual downloads, uploads, and updates of flat files
Top 3 Provider Network Management Credentialing Trends to Watch in 2024
The credentialing process for healthcare payers and provider organizations is a crucially important, ongoing administrative priority that must be done right. It’s like the foundation of a well-built house: with the right expertise and attention to detail, everything built on top of it is sturdy and resilient. But if that foundation isn’t solid, what comes next is going to be
Best Practices for Credentialing Committee Meeting Management
The National Committee for Quality Assurance (NCQA) mandates that health plans convene regularly to make decisions about the credentialing of their network practitioners. In these committee meetings, external experts assess whether providers qualify to remain in the network. While these meetings are essential for compliance, many health plans find it challenging to conduct them efficiently and effectively. We’re here to
Charting a New Course in Healthcare Compliance: A Spotlight on Our Latest Offerings
As healthcare advances and becomes more complex, compliance isn’t mere protocol—it’s the cornerstone of trust, bridging patient care and the intricate workings of organizational operations. Think of it not just as a rulebook, but as a silent sentinel, carefully preserving the integrity and security of healthcare practices against a backdrop of evolving standards and regulations. Fully understanding the nuanced relationship between
The Guide to Healthcare Provider Credentialing
The Guide to Healthcare Provider Credentialing We’ve got you covered with a handy all-in-one guide to credentialing – the what, when, where, and how in one place. Provider Credentialing in Healthcare Provider credentialing, also known as practitioner credentialing, is the process of verifying the qualifications, training, and professional background of healthcare providers or practitioners. Traditionally, credentialing is a time-consuming manual
Why improving the credentialing experience for providers matters
The 90 days plus time taken [for credentialing] is not acceptable. No one at the insurance company is available… emails are not responded to for many many days… talking to different people has no results. -Anthony D., healthcare provider When you ask a consumer what they think of the experience of procuring and receiving healthcare, chances are you’ll hear
Credentialing Issues in Healthcare
Credentialing is the process of verifying the qualifications and credentials of healthcare professionals in order to ensure that they are qualified to provide patient care. This process is critical for maintaining the quality of patient care and for protecting the public from unqualified practitioners. To combat the potential for intentional or unintentional data inaccuracies in the information provided by healthcare
How to automate provider credentialing
Credentialing plays a critical role in helping ensure that patients receive quality care from fully qualified professionals. Whether a provider applies to join a particular healthcare network or the network recruits the provider, the health plan–or any other healthcare payor offering services–must verify the provider’s credentials. Because of the legal and regulatory consequences that could ensue from healthcare decisions and
PPHP Credentialing with a Human Touch, Turbocharged by Technology
When Humana began searching for a new CVO partner, they had clear criteria – their next vendor had to be a long-term solution to their problems. Our unique approach enabled Humana to proactively identify potential compliance issues and mitigate them before consequences arose.
Building a Medicare Advantage Network for a National Health Plan
A national health plan wanted to expand their Medicare Advantage (MA) offerings. Their goals were to offer new MA plans in two states with established product lines and launch MA plans in three new states. To achieve these goals in an acceptable time frame, the health plan needed every resource available. Unfortunately, they ran into a challenge: their internal network development team had no bandwidth due to other projects and the available resources on their commercial team did not have any experience with Medicare Advantage requirements.
Humana Chooses andros as CVO Partner
When Humana began searching for a new CVO partner, they had clear criteria – their next vendor had to be a long-term solution to their problems. Our unique approach enabled Humana to proactively identify potential compliance issues and mitigate them before consequences arose.
Delegated Credentialing: Easing the pain of credentialing your providers
Delegated Credentialing: Easing the pain of credentialing your providers Credentialing in house can be painful for health plans and other types of payors, adding the time and administrative stress of continually tracking and updating new providers, locations, and information. It can be burdensome for provider organizations too, submitting new documents with each provider, location and information changes, not to mention
Top 4 Challenges Facing Health Plans in 2022 and How to Overcome Them
From network development and staffing shortages to managing relationships in an increasingly digital world, health plans have a lot on their plates in 2022. How can leaders effectively navigate this difficult environment while continuing to provide exceptional services to members? Introduction Since the beginning of this tumultuous decade, health plans have been confronted with an unprecedented array of challenges.
Roadmap to Innovation: What Payers Need to Compete in the Digital-First Healthcare Environment
Innovation is no longer optional for established health payers and digital native startups. Without revamping inefficient processes, payers risk falling behind in the race for provider participating providers and market share.Here are the first steps payers can take on the path toward sustainable, successful innovation. Introduction The health plan marketplace is evolving quickly as changing demographics, new regulations,
Top 4 Steps for Getting Started with Delegated Credentialing
FREE EBOOK Delegated credentialing can save time, money, and effort for health plans and provider groups. But it’s not for everyone. Providers need to fully understand what’s involved and assess their readiness to take on enhanced credentialing responsibilities. Here’s how. Introduction Credentialing is a key part of the provider enrollment process with significant implications for patient safety, care quality, and
Credential Your Network While You Build It
Both network builds and credentialing rely on having accurate, up-to-date data. Consider integrating these two processes around a unified data resource to deliver the best results while saving time and money.
Credentialing verification organizations like you’ve never seen
Credentialing healthcare organizations has traditionally been difficult to manage efficiently. The lack of an industry standard, like the one NCQA offers for provider credentialing, leaves organizations and state regulatory entities to develop their own processes or requirements. Naturally, the result is a hodge-podge of standards with little consistency across the healthcare industry. The lack of an industry standard, however, does
Recredentialing Q&A – What You Need to Know
Q: What is recredentialing? A: Recredentialing is the process of periodically verifying and reviewing practitioner and facility qualifications and performance. It ensures providers continue to meet key standards for professional competence, conduct, and delivery of high-quality care. Recredentialing generally occurs every 1-3 years after the initial credentialing process. During recredentialing, licensure, education, training, malpractice claims, and other qualifications are re-verified.
Cough. Cough. Who’s there? Telemedicine Makes a case for Medical Credentialing
The age of telemedicine has arrived. But, regulations are still catching up with technology. So when you tap on your screen to connect with a doctor you’ve never met, how do you know that you’re seeing a well-trained, qualified provider? In 2014, telemedicine startups, like Doctors on Demand, saw a 130% increase in funding from the year before. And telemedicine
