Credentialing Resources

Take deep dives into credentialing news, best practices, and technology with the andros team.

Blog

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

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Blog

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

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Blog

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

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Blog

The Guide to Healthcare Provider Credentialing in 2023

We’ve got you covered with a handy all-in-one guide to credentialing in 2023! The what, when, where, and how in one place. Fun fact – did you know this practice goes all the way back to 1000 BC? See how much you really know about credentialing. What Is Provider Credentialing In Healthcare? Provider credentialing, also known as practitioner credentialing, is the

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Blog

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

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Blog

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

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Blog

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

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Case Studies

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.

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Case Studies

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.

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Blog

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

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White Paper

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.

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White Paper

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,

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eBook

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

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Blog

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

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Recredentialing
Blog

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.

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