Take deep dives into credentialing, provider network management, and healthcare administration news, best practices, and technology with expert members of 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
Employee Spotlight: Julie Dzurila
Julie is a talented leader and executive with a remarkable history of success managing and transforming large healthcare operations. As the Vice President of Operations, Julie leads the team responsible for optimizing processes to deliver an exceptional customer experience for clients. Julie has a strong background in credentialing and operational expertise and has been a great mentor to her team.
Winter Newsletter: Note from Mike Simmons
As I reflect on the accomplishments of our team over the last year, I’m proud that we were able to end the year on a strong note. Our mission to provide the best credentialing services for our clients remains unchanged. We have far exceeded industry standards, with faster turnaround times and more reliable results. As we look ahead, we remain agile and prepared to adjust for an ever-evolving market.
NCQA Credentialing Requirements
One of our goals for our blog is to demystify credentialing so we are creating a series especially for leaders and business process owners who want to gain a deeper understanding of the NCQA standards and credentialing guidelines but don’t have time to wade through 100 pages of regulations. In this series, we’ll break down what you need to know about credentialing,
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
The Inadequacy of Network Adequacy
CMS plays a critical role in establishing adequate standards for healthcare, especially for the underserved. This means that those who need care should be able to get it, when they need it, without unnecessary barriers preventing access to quality care. But how do those standards play out in real life? Download The PDF
What does good provider network management look like?
The challenges of building a provider network are well-known in the healthcare industry. Network development teams must identify sufficient healthcare providers and facilities within a geographic area to meet patient needs, then recruit, contract, and credential them. If they’re building a network for Medicare or Medicaid patients, meeting adequacy requirements and submission deadlines complicate the calculations required. Only then can
ACO Case Study
An Accountable Care Provider (ACO) had multiple challenges, including missing growth targets, inability to collect or analyze recruitment data, and having slow recruitment processes. andros helped to educate providers, generate new revenue, and automate data collection, storage and analysis.
Celebrating #OneTeam: andros Fall MVPs
Celebrating #OneTeam: andros Fall MVPs Each quarter we acknowledge the team members who went above and beyond in their role and who exemplified the andros values. All MVP winners are nominated by their peers or manager and the People Team identifies the MVPs (and some honorable mentions!) for the quarter based on these nominations. We love this opportunity to recognize
An Introduction to Delegated Credentialing
One thing is well known – credentialing can be a long and arduous process. A possible solution to this problem is delegated credentialing, but many do not know where to start. While it might seem like a big undertaking, with the right preparation and partner, it can be a straightforward process. We’ve created an introduction to delegated credentialing breakdown so
Is Adequacy Enough? Moving Beyond CMS Standards for Provider Networks
Meet Grace Meet Grace. She’s a 70 year-old immunocompromised woman living in a rural area. She owns a car but doesn’t drive anymore, so she relies on her son for transportation. When she’s able to schedule her medical appointments well in advance, he’s able to take time off to drive her to them. But what happens when she comes down
Q3 Primary Care Provider Market Study
“ Primary care providers are more interested in acquiring new patients with their existing health plan contracts then they are in signing contracts with additional health plans ” andros executed our Q3 Provider Market Study to better understand primary care provider sentiment around network contracting and access to specialist providers for their patients. Part of what compelled us to focus
More Than Adequate: Paving the Road to Health Equity with Next-Gen Provider Networks
Download Our Whitepaper “ Of all forms of inequality, inequality in health is the most inhumane ” There are three main contributing factors for health inequality in the U.S.² — not to mention how we structure them to serve the needs of communities. Although provider network adequacy standards exist at the federal level and are one of the ways that
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.
Becoming a Medicare Advantage Plan of Choice for Providers
Effective, high-performing providers are the lifeblood of a successful healthcare network. When they’re not worried about things like paperwork and reimbursements, providers can focus on their patients and deliver quality care. On the flip side, providers who spend too much time behind a desk, dealing with administrative headaches rather than treating patients, struggle to do so. In the increasingly competitive
Improving the Patient Experience Using NCQA Report Cards
NCQA, the National Committee for Quality Assurance, is very clear about its mission: “We work for better health care, better choices and better health.” One tool they use to improve care is the NCQA report card program. NCQA report cards evaluate clinicians, practices, and health plans on a simple five star grading system. Since NCQA issues report cards for health
Fall 2022 Newsletter: Note from Mike Simmons
As we progress through the 4th quarter of 2022 and start looking ahead to 2023, change is again in the air. We are committed to becoming ever-better partners to our customers. For me living that commitment means talking to our customers and in Late August I set a goal of meeting with 30 customers over 60 days — it’s been super rewarding.
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.
Solving the Top Provider Data Challenges in Network Development
Organizations of all sizes have struggled to solve the challenges of building healthcare provider networks, especially for Medicare Advantage, on schedule and on budget. Healthcare organizations have to analyze patient demographics and local geography, then make wise choices where to invest. They need to comply with complex regulatory requirements and demanding timelines. But despite these geographic and regulatory challenges, provider