Audits happen. After all, compliance is the reason behind the credentialing process. But audits don’t have to be so time and resource consuming that they bring your department to a halt. andros not only simplifies the credentialing process, but simplifies the auditing process as well. Here’s how:
During a typical NCQA audit or an annual delegation audit, auditors will ask to review a dozen or so files from the period since the last audit, and they will review them with a fine-tooth comb. They will also review your credentialing bylaws and workflow to make sure your credentialing process meets NCQA’s industry standards or the regulatory requirements outlined in your delegation agreement.
What an audit looks like for a plan not using a CVO
If your credentialing committee is already facing a backlog or is at capacity processing incoming provider files, the time it takes retrieve 12 specific provider files can be painful. Depending on how your team manages the credentialing “paper trail,” pulling files for an audit could take hours or days away from your regular to-do list.
Evaluating audit readiness:
- How long does it take your team to find a provider file? Does your team have to dig through spreadsheets or riffle through filing cabinets to find old provider files?
- Do you have clear documentation of your credentialing bylaws and processes to share with auditors?
What an audit looks like with a legacy CVO
With a legacy CVO, audits can still be painful. A plan will have to request provider files from their CVO. Depending on their responsiveness, it could takes days or weeks for the CVO to fulfill the request. Then your credentialing team will have to organize and appropriately prepare the file for the auditors. If the CVO is not NCQA certified, the NCQA auditors will also need to review your internal bylaws and processes even though you’ve delegated the bulk of the task to the CVO.
Evaluating audit readiness:
- How responsive is your CVO to requests for provider files? Do the returned files require a ton of work and attention from your credentialing team?
- Do you have clear documentation of your credentialing bylaws, processes and how you work with your CVO?
What an audit looks like with andros
As an NCQA-certified CVO, andros does the heavy lifting to meet NCQA’s credentialing standards. Since NCQA has already reviewed our credentialing process, when it comes time for an audit, our clients receive an automatic pass on their credentialing bylaws. Those with in-house teams will have to spend a ton of time on this portion of the audit and we have seen a lot of plans whose bylaws are not set up correctly.
Plus, when your team needs to pull provider files for review, there’s no digging or waiting required. All historical data is at your fingertips through our cloud-based platform so your team can pull files without notice in a matter of minutes. Any time.
Evaluating audit readiness:
- With andros, audits require less NCQA review; files are accessible and ready for the auditors in a matter of minutes.
- Audits are completed quickly and smoothly, and your team’s attention isn’t diverted from regular work for long.
No headaches. No hassle.
Remove the burdens that come with legacy credentialing processes
andros can help relieve not only the audit burden for your team but also the burden of tedious data entry and lengthy committee prep. Let’s talk. >>
