Credentialing Resources
Take deep dives into credentialing news, best practices, and technology with the andros team.
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 some
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
The lesser-known process affecting healthcare quality: Credentialing
Board of Directors Investor Portal The lesser-known process affecting healthcare quality: Credentialing By Mark Hirschhorn Over the last two years, we’ve gained more insight into the inner workings—and over-burdening—of the healthcare system than ever before. However, most people are still unaware of how much time-intensive administrative work is involved in the healthcare they receive. This work which takes countless hours
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
Innovation is the answer: Why andros built the industry’s first API for NCQA-certified credentialing
You don’t need to be a rocket scientist to figure out that there are some big issues in the US healthcare system today. As a country, we’re spending almost one in every six dollars in the world’s biggest economy on healthcare, and we’re still not getting the results we deserve. In fact, we’re wasting immense sums of money on healthcare.
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: How often are practitioners recredentialed? A: Practitioners and facilities are typically recredentialed every three years unless a state or health plan has different requirements. It is important to recredential practitioners and facilities in order to verify their ability to continue providing the services for which they are contracted. Q: What preparation is needed to begin the recredential process? A:
Best Practices for Credentialing Committee Meeting Management
As you probably already know, NCQA requires health plans to meet periodically to make credentialing decisions about network practitioners. During this process, known as a committee meeting, outside experts will determine whether providers should continue to be credentialed for the network. These regular meetings are critical for health plans’ compliance, but many plans struggle when it comes to running committee
